Privacy Forms

• ECU Authorization for Use or Disclosure of PHI
• ECU Authorization for Use or Disclosure of PHI (Spanish)
• ECUH Authorization & Consent for Release of Protected Health Information (PHI) (for ECU Health use only)
• ECUH Authorization & Consent for Release of Protected Health Information (PHI) (Spanish) (for ECU Health use only)
• ECU Patient Revocation of Authorization for Use or Disclosure of PHI
• ECU Patient Request for Termination of Previously Approved Restrictions on the Use and Disclosure of PHI
• ECU Individual Request for PHI
• ECU Individual Request for PHI (Spanish)
• ECU Privacy Complaint Form
• ECU Request for Amendment of Protected Health Information
• ECU Request for Alternate Communication
• ECU Request for Accounting of Disclosures of PHI
• ECU Accounting of Disclosure Log
• ECU Accounting of Disclosures Log for 50 or More Individuals
• ECU Request for Restriction on the Use & Disclosure of PHI
• ECU Business Associate Agreement (BAA)
• ECU Notice of Privacy Practices (English)
• ECU Notice of Privacy Practices (Spanish)
• Data Use Agreement