ALERT BAR

The Privacy Office

(HIPAA, FERPA, etc.)

Patient Privacy(HIPAA)

Forms

The forms below are available by clicking here:

  • Authorization for the Release of PHI by UTMB(English)
  • Authorization for the Release of PHI by UTMB(Spanish)
  • Authorization to Release PHI to UTMB
  • Request for Correction/Amendment of PHI
  • Authorization/Consent to Photograph/Video Patients
  • Revocation of Authorization to Release PHI
  • Consent for Manufacturer Patient Assistance Programs