Clinic Forms & Documents

Immunizations

Adult Immunizations Schedule
- View the recommended immunizations and at what age to receive them according to the CDC.
Travel Questionnaire
- Are you traveling out of the country and need to be sure you have the recommended and required vaccines? Fill out our travel questionnaire and our team will review it and get you scheduled for your travel clinic appointment.

General

North Carolina Minor Consent Law
- Learn how we serve minors at the health department and what’s required by law.

Health Information Exchange

NC HealthConnex Minor Opt Out Form (English)
- When you present to your appointment as a minor and wish not to have your medical record shared with other local participating providers, you will sign this form within the office and present it at check-in. OCHD will submit this form on your behalf to not share that date of service to the NC Health Connex Portal.
NC HealthConnex Minor Opt Out Form (Spanish)
NC HealthConnex Adult Patient Opt Out Form (English)
- OCHD participates with NC HealthConnex which allows other participating providers to have access to your medical records for services that you receive here at the Health Department. If you wish not to have your information shared, adults must fill this form out and mail it to the address on the form to have your records removed.
NC HealthConnex Adult Patient Opt Out Form (Spanish)
NC HealthConnex Patient Education
- Learn more about the benefits of NC HealthConnex. If you would not like to participate, please fill out the form below.

Medical Records

Demographic Change Request
- The Demographic Change Request form can be used to change information on your medical records for reasons such as marriage, divorce, court order/naturalization, or misspellings.
Patient Right of Access (Spanish) (Records Request Form) Please email a copy of your photo ID with the request.
Patient Right of Access (Records Request Form) Once you complete the form, check your email and click the link to sign the form electronically. For Validation and consent, once signed, a photo of the patient's ID (front and back) will be required for submission.
- If you’ve been at the health department for services and need information or records regarding those services, fill out the Patient Right of Access to allow the health department to release those records to you or a facility of your choice.

HIPAA