University of Rochester

Federalwide Assurance


University of Rochester

FWA00009386
Expires: January 11, 2014
Read the Assurance.

Highland Hospital

FWA00002728
Expires: June 02, 2013
Read the Assurance.

HIPAA Authorization for the Release of Medical Information

To ensure that the nine required elements of a HIPAA compliant authorization are contained in release of information requests, the Authorization Form SH 48 may not be altered, with the exception of the contact information in the upper right-hand corner. Please call Brenda Tryon at L.L. Donnelly at 249-7703 to provide the appropriate contact information for your study and to order the forms.

A sample of this form can be viewed here.