Confidential Health History and Limited Authorization Form

Log on to the UHS eTang patient portal to fill out and submit the Confidential Health History and the Limited Authorization Form. If you have never accessed the site you will be asked to complete the "Required Privacy Notice" and the "Required Statement of Financial Responsibility" first.

 

You can find the forms on the left hand side of your eTang portal under “Medical Clearances.” This tab will appear once your forms are available. (see below)

It is the student's responsibility to check their UCEAP Pre-Departure Requirements to see if they need any program or country specific forms as part of their Health Clearance process. If you need to submit country-specific forms, log into eTang and select Messages. Click on the New Message button. Select "Contact a member of my Primary Care Team." Please include copies of your country specific forms, name, SID, UCEAP program name and country, and term in the message.

The Tang Center will communicate with you via secure message on eTang. Please check your secure messages regularly.

After you fill out the online Confidential Health History Form and Limited Authorization Form on the eTang portal, a Nurse Practitioner or physician will conduct a Health History Review of your previous and ongoing medical history without your being present. You do not need to make an appointment with Tang to have them complete this review. 

If needed, the Tang Center staff will follow up with you through eTang secure message which may include requests for additional information before your clearance can be processed. Be sure to check your eTang secure messages regularly for any communication and read these instructions carefully. If requested, completed supplemental forms need to be submitted via instructions in your secure messages. Tang Center staff cannot proceed with the health clearance until additional requests, including supplemental forms, have been completed.

If additional steps are required, it will take time to complete these next steps and you are responsible for requesting an extension from your UCEAP Program Specialist if there is a chance your clearance will not be turned in by the deadline.

If 3-4 weeks have passed after you uploaded your forms on eTang and you have not received an eTang secure message yet, please contact the Tang Center by either:

a) Logging into eTang and select Messages. Click on the New Message button. Select "Contact a member of my Primary Care Team." Please include your name, SID, UCEAP program name and country, and term in the message.

b) Call and leave a message for the UCEAP Health Clearance Coordinator at (510) 643-5403. This phone number is not staffed every day. Please note that you may have to wait several days for a response if you place a call on a Friday.

If you have questions for the Tang Center Staff, you can contact them in two ways:

a) Log into eTang and select Messages. Click on the New Message button. Select "Contact a member of my Primary Care Team." Please include copies your name, SID, UCEAP program name and country, and term in the message.

b) Call and leave a message for the UCEAP Health Clearance Coordinator at (510) 643-5403. This phone number is not staffed every day. Please note that you may have to wait several days for a response if you place a call on a Friday.

The charge for the Health History Review is $25.50, payable to the Tang Center. This fee is the same for all UCEAP students, whether or not the student is covered by SHIP, and will be billed to your CalCentral account. If you fill out and submit forms on eTang, you will be billed the $25.50 cost even if you withdraw from your program before the departure date.

The Tang Center processes forms according to program due date. They will make every effort to complete processing within one week or more of the due date.

Please check for eTang secure message notifications regarding clearance processing. When your Health Clearance is completed by the Tang Center, you will be notified via email to check the eTang portal for a secure message. Please carefully review all information in the secure message.

If you uploaded your forms to eTang late (less than 5-6 weeks prior to your deadline), and you have not received your UCEAP Health Clearance by the deadline, please first check your eTang secure messages. If you do not have an update in your secure messages, please email your UCEAP Program Specialist to request an extension of your deadline. The Tang Center does not expedite review for students who submit their forms on eTang late.

Please refer to the Chile-Specific Health Clearance Instructions located in your UCEAP Predeparture Requirements.

Take your Confidential Health History form with you abroad for personal reference—do not submit this form to UCEAP.

If  there  are  any  changes  to  your  health  after  submitting the  health  clearance  form,  you  must  notify  UCEAP.  You  may  be required to submit an updated health clearance or treating doctor’s letter.