Office of Legal Affairs
Health Sciences Campus
腦瞳憫 takes privacy rights seriously. The following forms are necessary to assist with a variety of situations involving privacy.
Protecting personal records is of utmost importance. 腦瞳憫 prohibits unauthorized access or disclosure.
Disclosure Declaration-Breach Mitigation
If you receive health information or other confidential information you did not request, please complete this form.
Privacy Incident Intake Report
Report a privacy incident to Compliance, Ethics & Risk Management.
Please use this cover sheet when faxing confidential health care information.
Law Enforcement Request for PHI
When receiving a request for information from law enforcement, please complete this form and adhere to its guidelines.
If you're not able to locate a device containing sensitive data, please complete this form as soon as possible.