Forms & Documents

• Access to Corporate Email on Phone-Attestation Form Signature required PRIOR to synchronization to email
• Data Request Form
• Data Request Form Instructions
• Data Use Agreement
• Fax Coversheet Tips for appropriate faxing
• Fax Coversheet Sample
• Fax Number Verification Form
• Report of Lost or Stolen Computer Device or Electronic Media

Acknowledgment of Email User Responsibility

• Acknowledgment of Email User Responsibility

Photography Policies and Guidelines

• Authorization and Consent to Record Audio and/or Video, Photograph, Write and Publish Form #23-2137 - English  |  Spanish  | Digital
• Photography Guidelines
• Taking Patient Photographs – Summary
• Use of Photographs for Non-Treatment purposes – Quick Decision Tool
• Patient Photographs - FAQs

Business Associate Agreement (BAA)

• Entity-specific Business Associate Agreements

Privacy and Security Rules of Conduct

• Privacy and Security Rules of Conduct Form

Department Self-Monitoring & Assessment Tools Form

• Department Self Monitoring and Assessment Tool 

Authorization to Use/Capture PHI on Portable Devices or Removable Media Form

• Authorization to Use/Capture PHI (All entities)
• Requirements and Guidelines for Protection of Private Data Stored on Laptops/Portable Devices

Notice of Privacy Practices Forms

• Notice of Privacy Practices
• Aviso de Procedimientos de Privacidad 
• Patient Information Sheet Notice of Privacy Practices
• Notice of Privacy Practices Summary  –  English  |  Spanish