This form must be completed by anyone whose likeness appears in our print or online publications. This includes all faculty, fellows and staff. If the individual is a patient, they must also complete the "Authorization for the Use and Disclosure of Protected Health Information" form below.
This HIPAA-compliant form grants Baylor College of Medicine permission to use and release specified health information (such as photographs of patients) for purposes other than treatment, payment, and health care operations (eg, media coverage, presentations or research). For more information see the HIPAA Program section on the BCM Intranet.