Release of Information

Clinical Care Forms

Authorization for Release of Medical Information

Authorization for Sharing of Information: Patient to Patient

Release to Inspector Access

Request for Amendment of Health Information

Non-HIS Preapproved Release of Information Scenarios/0340

Request for Non-Disclosure of Health Information to Health Plan

Request for Medical Records (non-patient care purposes)

Request for an Accounting of Disclosures

Request for Restriction on Uses & Disclosures of Health Information

UVaHS Medical Records Request Options

Authorization for Access by Hospital Education

Parent/Legal Guardian Proxy Access to MyChart

Parent/Legal Guardian Proxy Access to MyChart (Spanish)

Adult Proxy Access to MyChart by Adult

Adult Proxy Access to MyChart by Caregivers