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/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Clinic-Manual-local.json

/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Clinic-Manual.json

HIPAA-Related Forms

Subject: III. Clinical – F. HIPAA

Effective Date: 09/01/2017

Reviewed and/or Revised: 09/01/2017

The following are University of Maryland, School of Dentistry HIPAA-related Forms:

• Authorization for Use and Disclosure of Protected Health Information (PDF)
• Amendment Correction Request Form (PDF)
• Acceptance of Amendment Correction Form (PDF)
• Business Associate Agreement (PDF)
• Confidentiality Agreement for Visitors (PDF)
• Confidentiality Pledge (PDF)
• Denial of Amendment Correction Form (PDF)
• Disagreement with Denial of Amendment Correction Form (PDF)
• Extension to Respond to Amendment Correction (PDF)
• Notice of Privacy Practices (PDF)