Patient Forms 

Physician Forms

Release of Medical Information

The University of Utah Health Science Center follows the Federal requirements for protection of your personal medical information. If you would like the University of Utah Health Sciences Center to share (or receive) your medical health information with anyone (spouse, family member, other health care provider, etc.) you must give written permission. Please use the Patient Authorization Disclosure or Receipt of Protected Health Information form to give permission. Please read and complete the entire form.

Please note: Your signature must be witnessed by a UUHSC employee or a notary public.