Index of Forms

Below is an index of all forms included in the Health Care Component Providers' Privacy Policies and Procedures:

• Acknowledgment Cover Sheet
• Notice of Privacy Practices
• University Privacy Officer Description
• Amendment/Correction Request Form for Protected Health Information
• Restriction Request Form for Protected Health Information
• Access Request Form for Protected Health Information
• Confidentiality Agreement
• Authorization for Disclosure of Patient Medical/Health Information
• Request for Accounting of Disclosures of Patient Protected Health Information
• Patient Record of Disclosures
• HIPAA Complaint Process
• Business Associate Agreement

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