Documents

• Notice of Privacy Practices – HTC HBF
• Notice of Privacy Practices – HCI
• HIPAA Authorization to Release PHI from Health Centers
• Formulario De Consentimiento General Para Tratamientos de Rutina – Medico
• General Consent Form
• Welcome Packet
• Authorization to Obtain Health Information from External Providers
• Summary of Material Modifications (SMM) for the ITP & Scholarship Fund
• Permission to Verbally Discuss Protected Health Information with Family and Friends
• Health Benefits Enrollment Form
• Life Insurance Beneficiary Form
• Change of Address or Phone Number Form
• Change of Personal Identification Information Form (for name, DOB, and SSN changes)
• Domestic Partnership Package
• Disability Form Spanish 2022

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