Privacy Health Forms

• Incident Notification Form (formerly Breach Notification Form)
• Confidentiality Agreement
• Receipt of UNM HSC Privacy Notice - English
• Receipt of UNM HSC Privacy Notice - Spanish 
• Receipt of UNM HSC Privacy Notice - Vietnamese
• Patient Rights and Responsibilities - English
• Patient Rights and Responsibilities - Spanish
• Patient Rights and Responsibilities - Vietnamese

Authorizations

• Authorization and Release for the Use and/or Disclosure of Protected Health Information for Marketing and Communications - English
• Authorization and Release for the Use and/or Disclosure of Protected Health Information for Marketing and Communications - Spanish
• Authorization and Release for the Use and/or Disclosure of Protected Health Information for Marketing and Communications - Vietnamese
• Authorization for Use and Disclosure of Limited Health for Fundraising Purposes - English
• Instructions to Request Health Information - English
• Instructions to Request Health Information - Spanish
• Instructions to Request Health Information - Vietnamese
• Authorization to Request Health Information - English
• Authorization to Request Health Information - Spanish
• Authorization to Request Health Information - Vietnamese
• Authorization to Use or Disclose Health Information - English
• Authorization to Use or Disclose Health Information - Spanish
• Authorization to Use or Disclose Health Information - Vietnamese

Requests

• Request for Accounting of Disclosures
• Request for Amendment of Health Information
• Request for Restriction of Health Information