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General Medicine

Non-Psychiatric Medical Withdrawal and Re-enrollment Forms and Letters

If you have received a medical withdrawal for non-psychiatric reasons and if your dean has asked that you receive "medical clearance" through General Medicine, the following documents which are in PDF format are available to be printed for your use. These documents describe what is required of you and your treating health-care provider in order for you to receive medical clearance for reenrollment.

Letter to Student - Provides an overview of the process of obtaining medical clearance for reenrollment.

Letter to Health-Care Provider - Provides explanation of the documentation needed by General Medicine in order to provide medical clearance and make a recommendation to the student's academic dean regarding reenrollment.

Form to be Completed by Student's Health-Care Provider - This form must be completed and returned to General Medicine. General Medicine clinicians will review the documentation and forward a recommendation to the student's academic dean regarding the student's readiness to reenroll. If the documentation from the student's treating provider is inadequate, or if the student's academic dean has specifically requested an in-person reenrollment assessment, then the student will need to make an appointment with General Medicine for this purpose.

Student Reenrollment Information Update

This form provides General Medicine with your current contact information in the event that a General Medicine professional needs to speak with you about your request for medical clearance for reenrollment.

Consent for Communication with Academic Dean

This form provides General Medicine with permission to convey recommendations to your academic deans regarding your reenrollment. This form should be completed and returned to General Medicine at the time that reenrollment is being requested.

Dean's Notification to General Medicine of Student Medical Withdrawal - Unlike the forms listed above, this form is not intended for student use. It is to be used by UVa academic deans to notify General Medicine that a medical withdrawal has been issued. The form also stipulates the nature of the reenrollment assessment requested by the dean. It should be completed by academic deans who are choosing to utilize General Medicine for reenrollment consultation. The form should be sent to General Medicine at the time of a student's withdrawal.