TTUHSC Universal HIPAA Forms
General Universal HIPAA Forms
| Confidential Communication Request Form (Instructions) | English Version | Spanish Version |
| Consent to Treatment (Guideline) | English Version | Spanish Version |
| Request to Amend PHI Form | English Version | Spanish Version |
| Privacy Complaint Form | English Version | No Spanish Version Available at this time |
| Request for Accounting Form | English Version | Spanish Version |
Photo Consent Form
| Consent & Release to Use Image or Information Form (see HSC OP 52.15) |
English Version | Spanish Version |
Notice of Privacy Practices
| Notice of Privacy Practices Handout | English Version | Spanish Version |
| Notice of Privacy Practices Handout (Lubbock Only) | English Version | Spanish Version |
Business Associate Agreement Information
| HIPAA Business Associate Agreements (see HSC OP 52.13) |
Business Associate Agreement Form | Guideline for Use |
HIPAA Research Study Forms
| Authorization to Use and Disclose PHI for Research Study | English Version PDF Format Word Format |
Spanish Version PDF Format Word Format |
| Addendum to Authorization to Use and/or Disclose PHI for Research Study | English Version | Spanish Version |
| Principal Investigator's Request to Use and Disclose PHI without an Authorization | English Version PDF Format Word Format |
No Spanish Version Available at this time |
Need more Forms?
Campus-Specific Forms Available, just choose your Campus Below.
Amarillo HIPAA Forms Page
Permian Basin HIPAA Forms Page
El Paso HIPAA Forms Page
Lubbock HIPAA Forms Page