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BDC HIPAA Forms & Instructions

Please visit the UCD HIPAA site for more detailed information and explanations about UCD HIPAA policies on privacy and security.

  1. Notice of Privacy Practices
    Patient is required to read the Notice of Privacy Practices:
    English: NPP.PDF
    Spanish: NPP.PDF
    Patient is required to sign the following acknowledgment that they received a copy of the Notice of Privacy Practices:
    English: NPP Acknowlegment.PDF
    Spanish: NPP Acknowlegment.PDF
  2. BDC Admission Form
    BDC Admission
  3. BDC Authorization Research Form
    BDC Authorization
  4. Shadowing Instructions and Related Forms
    BDC Shadow Instructions
    Exhibit A: Decription of Hosting Purpose
    Exhibit B: Volunteer Agreement and Waiver
    Exhibit C: Confidentiality Agreement for Shadowing
  5. PHI Release Instructions and Related Forms 
      PHI Instruxns
      PHI Tracking
      PHI Request
      PHI Permission
​ 6. ​Social Security Administration Instructions and Sample Form
      PHI Instructions
 7.  SSA Release.PDF

For further information on BDC HIPAA Policies please contact the BDC HIPAA Policy & Security Officer​.