Forms

  HIPAA Privacy and Medical Record Forms

04	Acknowledgement of Receipt of Notice of Privacy Practices (NPP)
05-C	Denial of Individual's Request for Protected Health Information
05-D	Authorization for Verbal Release of Protected Health Information
06-A	Health Sciences Center — Request for Accounting of Disclosures
06-B	Norman Campus — Request for Accounting of Disclosures
06-C	Accounting of Disclosures
06-D	George Nigh Rehabilitation Institute — Request for Accounting of Disclosures
07-A	Health Sciences Center — Request for Alternative Means of Communication
07-B	Norman Campus — Request for Alternative Means of Communication
07-C	George Nigh Rehabilitation Institute — Request for Alternative Means of Communication
08-A	Health Sciences Center — Request for Amendment of Protected Health Information
08-B	Norman Campus — Request for Amendment of Protected Health Information
08-C	Amendment Acceptance Notification Form
08-D	George Nigh Rehabilitation Institute — Request for Amendment of Protected Health Information
09-A	Health Sciences Center — Request for Restrictions on Use and Disclosures of Protected Health Information
09-B	Norman Campus — Request for Restrictions on Use and Disclosures of Protected Health Information
09-C	George Nigh Rehabilitation Institute — Request for Restrictions on Use and Disclosures of Protected Health Information
11	HIPAA Privacy Complaint Report
18	Fax Cover Sheet for Protected Health Information
21	Employee Role-Based Access Worksheet
23-A	Health Sciences Center — Request for an Individual's Health Information/Authorization to Release
23-B	Goddard Health Center — Request for an Individual's Health Information/Authorization to Release
27	Business Associate (BA) Decision Chart
30-C	Training and Education Request Form
33-A	George Nigh Rehabilitation Center — Directory Opt-Out Form
34	University of Oklahoma Confidentiality Agreement
35	Consent for In-Office Treatment and Payment
36	Notice of Disclosure of Personally Identifiable Student Information

Instructions for Customizing Organizational Logos in HIPAA Forms

Consent for Electronic Communications Form

 Medical Record Log Forms

 Athletic Department Authorization Form

Document 27 — Business Associate Decision Chart is a PDF. If you need a PDF reader, you can download one from here.