Lubbock Forms
Authorization for Release of Patient Information |
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General |
English | Spanish |
Department of Psychiatry |
English | Spanish |
Family Medicine |
English | Spanish |
International Pain Center |
English | Spanish |
Mobile Mammography Clinic |
English | Spanish |
MPIP Business Office |
English | Spanish |
Ophthalmology |
English | Spanish |
Pediatrics C.A.R.E. Center |
English | Spanish |
Pharmaceutical and Infusion Care Center |
English | Spanish |
School of Nursing Wellness Center |
English | Spanish |
Southwest OB/GYN |
English | Spanish |
Speech-Language & Hearing Clinic |
English | Spanish |
Student Health Services |
English | Spanish |
Texas Tech Diabetes Education Center |
English | Spanish |
University Family Physicians |
English | Spanish |
Authorization for Release of Psychotherapy Notes |
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General |
English | Spanish |
Family Medicine |
English | Spanish |
Neuropsychiatry, Division of Psychiatry |
English | Spanish |
University Family Physicians |
English | Spanish |
Business Associate Agreements for Contracts and Purchase Orders |
PDF Format | |
HIPAA Security Amendment(For all agreements executed before April 21, 2005) |
PDF Format | Word Format |
Confidential Communication Request |
English | Spanish |
Consent to Treatment |
English | Spanish |
Complaint |
English | Spanish |
Request for Accounting |
English | Spanish |
Request to Amend PHI |
English | Spanish |
Release for Media Purposes |
English | Spanish |
HIPAA, Texas Tech University Health Sciences Center
806-743-4007 Fax 806-743-1515