The University of Arizona

HIPAA Forms

Report Misconduct

Ethics Hotline

HIPAA Privacy Links

Report a Privacy Incident

Submit a Business Associate Agreement Request
Submit a Data Use Agreement Request

Contact the HIPAA Privacy Program
Katherine Georger, JD, CHC, CHRC, CIPP/US
HIPAA Privacy Officer
EmailPrivacyOffice@email.arizona.edu
Phone: 520.621.1465
Fax: 520.621.3355

Street Address:
1618 E. Helen Street
Tucson, AZ 85719

Mailing Address:
Attn: Privacy Officer
The University of Arizona
PO Box 210409
Tucson, AZ 85721

*Subscribe to the HIPAA Program listserv

HIPAA Privacy Program Updates
HIPAA Training now in UAccess Learning
*NEW: HIPAA Data Reference Guide
*NEW: Report a Privacy Incident

HIPAA in the News
HIPAA Enforcement Activities
HHS Off for Civil Rights YouTube Channel

Form B: HIPAA Authorization Template (PDF)
Form C: Denial of a Request for PHI (PDF)
Form D: Request for an Accounting of Disclosures of PHI (PDF)
Form E: Accounting of Disclosures of PHI (Documentation Form) (Word)
Form F: Accounting of Disclosures of PHI for Research (Word)
Form G: Accounting of Disclosures of PHI (Internal Tracking Form) (PDF)
Form H: Request for an Amendment of PHI (PDF)
Form J: Template Letter: Delay in Processing Request to Amend PHI (Word)
Form K: Template Letter: Denial of Request to Amend PHI (Word)
Form L: Notice of Privacy Practices (Checklist) (PDF)
Form M: Template Letter: Request for Confidential Communications/Restriction (PDF)
Form O: Data Request Agreement Request (PDF)
Form P: De-Identification of PHI (PDF)
Form Q: Is it PHI? (PDF)