HIPAA Related Forms

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects sensitive patient health information from being disclosed without the patient’s consent or knowledge.

Request for Authorization English | Spanish

Request for Access English | Spanish

Request for Restrictions English | Spanish

Request for Confidential Communications English | Spanish

Request for Amendment English | Spanish

Request for Accounting of Disclosures English | Spanish

Attestation Regarding a Requested Use or Disclosure of Protected Health Information Potentially Related to Reproductive Health Care English | Spanish

To understand what type of form to use, click here (Spanish)