Forms & Policies

Coming to the hospital or clinic? Find current patient & visitor policies.

Patient Rights & Policies

HIPAA: Your Privacy

We keep your medical records and health information private, complying with HIPAA. View:

Medical Records Release Forms

Allow the sharing of your medical records and/or health information with a third party: 

Request limits on who receives some or all of your health information:

Prevent disclosure to your health insurance of a healthcare service that you have paid for in full:

Allow a provider to share your medical information with another patient:

Find out when and to whom your health information was shared:

Ask for changes or corrections in your medical record: 

Allow UVA Health to disclose a substance abuse disorder

MyChart Forms: Access Requests

Request access for another adult to your MyChart account: 

Request caregiver access to an incapacitated adult's MyChart account: 

Access to a Child's MyChart

Request access to a child's (under age 13) MyChart account:

Request access to an adolescent child's (over age 13) MyChart account:

Give the Hospital Education Program access to your child's medical records: 

Delegation of Authority

Use a Delegation of Authority to give another family member or trusted adult permission to bring a minor for routine care and treatment.

Advance Directives

Use an advance directive to plan your future medical care and health decisions.

Choose your advance directive form options.

Clinic Late, No-Show, & Cancellation Policy

See information about our late, no-show, and cancellation policy on our appointments page.