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 (NOPP). The NOPP 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 Disclose Medical Information

Notice of Privacy Practices (NOPP)

NOPP Patient Acknowledgement Form

Privacy Rights Complaint Form

Additional Patient Forms