Forms

Please use the following forms to assist you in your privacy and information security compliance:

Business Associate Agreements
Please click here to obtain templates and other information about business associate agreements

Information Security Policy Exception Management Process

1. Policy Exception Request Template - Use this form to explain the details of your exception request.
2. Compliance Risk Acceptance Form - Part of the information security policy exception management process used to document any significant exception considered by the Review Committee. The form is designed to present the potential risk to the responsible department head, vice president and/or dean for their risk acceptance.

Notice of Privacy Practices
Please click here to obtain templates and other information about Notice of Privacy Practices

Research - Data Use Agreement

Please click here to obtain the template for the Data Use Agreement

Use and/or Disclosure of Protected Health Information Authorization Form
Generic form in word document format for your use. This form, as is, meets HIPAA requirements and has been reviewed by the Privacy Office.

A Spanish version of the Authorization is also available. The entity names displayed in red in the template can be in English.