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
- 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
- Instructions to Request Health Information - English
- Instructions to Request Health Information - Spanish
- Instructions to Request Health Information - Vietnamese
- Authorization to Request Health Information
- Authorization to Request Health Information - Spanish
- Authorization to Request Health Information - Vietnamese
- Authorization to Use or Disclose Health Information
- Authorization to Use or Disclose Health Information - Spanish
- Authorization to Use or Disclose Health Information - Vietnamese
Requests
HSC Privacy Office
MSC08 4760
1650 University Blvd. NE
Albuquerque, NM 87131-0001
Physical Location:
HSC Business & Communications Center
Suite 3200