Office of Institutional Compliance

Lubbock Forms

Authorization for Release of Patient Information

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

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

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