University of Maryland School of Dentistry

HIPAA and Compliance Policies

• Patient Bill of Rights
• CHC HIPAA Substitute Notice

Patient Forms

• Records Release Forms
  • Private Practice Records Release Request
    For use by UMSOD patients and private practice offices to request the release of patient records.
  • Authorization for the Use and Disclosure of Protected Information
• Health Record Correction Requests
  • Amendment Correction Request Form 
• Backline Patient Instructions