The University of Arizona


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HIPAA Privacy Links

Report a Privacy Incident

Submit a Business Associate Agreement Request

HIPAA Data Reference Guide


Department Email

John Howard, JD
Director, HIPAA Privacy Program
HIPAA Privacy Officer

Bill Murphy, CISSP
HIPAA Security Specialist

Suzie Williams
HIPAA Privacy Analyst

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

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Enforcement Activities
Office for Civil Rights YouTube Channel

Form A: Authorization for Release of Medical Information (PDF)
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 I: Template Letter: Denial of PHI Access (Word)
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 N: Fax Cover Sheet (PDF)
Form O: Data Use Agreement Request (PDF)
Form P: De-Identification of PHI (PDF)
Form Q: Is it PHI? (PDF)
Form R: Acknowledgment of Notice of Privacy Practices Receipt (Word)
Form S: Secure Media Destruction Record (Word)