Forms for BU Health Care Providers Danielsen Institute Authorization for Release of PHI (General Purpose Auth) Authorization to Disclose Health Info for Educational Purposes Authorization to Use and Disclose PHI in a Professional Publication Authorization for Other Providers to send Records to DI Notice of Privacy Practices Acknowledgement of NPP Request for an Accounting Request for a Restriction Request for Amendment of PHI Request for Confidential or Alternate Mode of Communication Request for Non-Secure Communication Request for Waiver- Preparatory to Research GSDM Dental Health Centers English Authorization for Educational and Academic Purposes Authorization to Use Dental Info in Publication Authorization for Other Provider Records to be Sent to GSDM Authorization to Release Dental Records Notice of Privacy Practices Request for an Accounting Request for a Restriction Request for Amendment Request for Confidential or Alternate Mode of Communication Request for Non-Secure Communication of My Protected Health Information Prep to Research Waiver Request Spanish Authorization for Educational and Academic Purposes Authorization to Use Dental Info in Publication Authorization for Other Provider Records to be Sent to GSDM Authorization to Release Dental Records Notice of Privacy Practices Request for an Accounting Request for a Restriction Request for an Amendment Request for Confidential or Alternate Mode of Communication Request for Non-Secure Communication of My Protected Health Information Sargent Choice Nutrition Authorization for Release (General Purpose Auth) Authorization to Disclose PHI for Educational Purposes Authorization to Use and Disclose PHI In a Professional Publication Authorization for Other Providers to send Records to Sargent Choice Notice of Privacy Practices Acknowledgement of NPP Request for an Accounting Request for a Restriction Request for Amendment Request for Confidential or Alternate Mode of Communication Request for Non-Secure Communication Requst for Waiver Preparatory to Research BU Rehabilitation BU Rehab General Authorization BU Rehab Authorization for Educational Purposes Authorization to Use PHI in a Professional Publication Authorization for Other Providers to send Records to BU Rehab Notice of Privacy Practices Acknowledgement of NPP Request for an Accounting Request for a Restriction Request for Amendment Request for Confidential or Alternate Mode of Communication Request for Non-Secure Communication Request for Waiver Preparatory to Research Request Form Forms for All BU Health Care Providers and Researchers Application for Exception to BU HIPAA Policies Authorization to Use PHI for Promotional Purposes Authorization to Disclose Health Information for Research Patient or Subject Request For Non-Secure Communication example form