I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:. The Office of the Registrar serves as the custodian of permanent academic records for all past and currently enrolled students.Pediatric medical records are available in MyChart. You can access your child's records and download PDFs of the records for free. Global Scholars harnesses the power of place through living and learning in two distinctive locations with a cohort of other Northeastern students. Complete the Request for Excused Withdrawal form. The form is fillable, once you have completed the form please save it with the changes to your computer. How This Medical Practice May Use or Disclose Your Health Information. All forms are also available on this website in their respective topic areas. If you cannot find the form you're looking for, please use our contact form.