Patient HIPAA Forms

The Health Insurance Portability and Accountability Act of 1996 includes a regulatory requirement to provide every new patient with the organization’s Notice of Privacy Practices (Notice). The Notice informs patients how their protected health information (PHI) may be accessed, used and disclosed by Columbia University Healthcare Component (CUHC) and how to exercise their rights with respect to their PHI. The forms below can be utilized to address your patient rights.

Authorization to Release Medical Information

Privacy Rights Complaint Form

Notice of Privacy Practices (NPP)

Patient Acknowledgement Form

Additional Patient Forms