TTUHSC Office of Institutional Compliance
HomeHIPAA

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 (NPP) 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

©