GU Forms

(Note: All forms on this page are in PDF format and require Adobe Acrobat Reader)

• FORM-04: Georgetown University Notice of Privacy Practices
• FORM-05.A: Individual’s Request for Protected Health Information
  
• FORM-06.A: Request for Accounting of Disclosures
  
• FORM-06.B: Accounting for Disclosures Form
  
• FORM-07: Request for Alternative Means of Communication
  
• FORM-08.A: Request for Amendment of Protected Health Information
  
• FORM-08.B: Amendment Acceptance-Notification Form
  
• FORM-09: Request for Restrictions on Use and Disclosure of Protected Health Information
  
• FORM-10: Privacy Official-Contact Information
  
• FORM-11: Health Information Privacy Complaint Form
  
• FORM-18: Fax Cover Sheet
  
• FORM-21: Sample Employee Role Based Access Worksheet
  
• FORM-23: Sample Authorization Form
  
• BA CHART: Business Associate (BA) Decision Chart
  
• FORM 27-A: Business Associate Addendum
  
• FORM-29: Authorization for Disclosure for Philanthropy
  

Georgetown University HIPAA Manual

• Document containing all HIPAA forms and privacy policies

Code of Ethical Conduct

Georgetown University Compliance Helpline