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Purdue University -

Procedures and Forms - General

Authorization for Use, Disclosure or Release of PHI and Medical Records Form (doc)

Breach Notification Policy (pdf)
Breach Notification Procedures (pdf)

Confidentiality Agreement - Form (pdf)
Confidentiality Agreement – Purdue Clinical Training Programs - Form (doc)
Confidentiality Agreement - Student Affiliation-Work External to Purdue - Form (pdf)
Confidentiality Agreement – Contractors - Form (pdf)

Confidential Destruction Certificate (pdf)  (doc)

Designation of Individuals Who are Involved in My Payment or Treatment Decisions - Form (doc)

Distribution of the Notice of Privacy Practices - Procedure (pdf)
Distribution of the Notice of Privacy Practices - Letter (doc)

Interview, Photograph and Audio Standard (pdf)

Minimum Necessary Policy (pdf)

Record of Disclosure (pdf)    (doc)

Record of Inadvertent Disclosure of PHI - Form (pdf)     (doc)
       Inadvertent Disclosure Confidentiality Agreement (pdf) (doc)
       Inadvertent Disclosure Disposal Verification (pdf) (doc)

Request of Amendment of PHI - Procedure (pdf)
Request of Amendment of PHI from an Individual - Form (pdf)     (doc)
Request of Amendment of PHI from an Entity - Form (pdf)     (doc)

Request of Confidential Communications (pdf)

Request for the Restriction of the Use or Disclosure of PHI - Policy and Procedure (pdf)
Request for the Restriction of the Use or Disclosure of PHI-Form (pdf)     (doc)

Tracking and Releasing Policy (pdf)

Workforce Training Policy (pdf)

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