HIPAA Authorization & Model Release Form
HIPAA Authorization Form
CU Anschutz must protect the privacy of patients and individuals disclosing health information. When capturing images or obtaining other personal health information from individuals, we are required under the Health Insurance Portability and Accountability Act (HIPAA) to obtain their permission to use the information or images by completing the HIPAA Authorization form.
- HIPAA Authorization Form (available in English and Spanish)
Model Release Form
The University of Colorado Anschutz Medical Campus requires model release forms to be obtained from individuals photographed, videotaped or recorded for content creation including staff, faculty and students (except for School of Medicine students or Skaggs School of Pharmacy and Pharmaceutical Sciences students).
This form is required to grant an entity permission to use the subject's image for educational, promotional, advertising or other purposes.
In cases where it’s not feasible to get a release signed for everyone at an event, we recommend posting a “crowd image release” sign at all entrances or including a statement in event materials. However, it is strongly encouraged that model releases be signed by all subjects when possible.
- Model Release Form (available in English and Spanish)
- Crowd Image Release Sign
Please do not alter these forms. If you require changes to it, please contact the CU Anschutz Office of Communications.