Forms

Patient Rights ​

Accounting of Disclosures Request ​

Accounting of Disclosures Request-WUPI

Alternative Methods of Communication​ Request

Amendment of Protected Health Information​ Request

Amendment of Protected Health Information Request-WUPI 

Medical Records Request

Medical Records Request-WUPI

Patient Communication Request

Restriction on Use or Disclosure of Protected Health Information Request

Restriction to Health Plan Request (Self-Pay)

Authorizations​

Email/Text Authorization

Joint Media Authorization

Confidentiality Agreements​

Confidentiality Agreement-Adult

Confidentiality Agreement-Minor

WU Business Associate Agreement (BAA)

Business Associate Agreement