Compliance & Privacy Office

Privacy Forms

If you have any questions or need assistance regarding privacy forms, please contact the Privacy Office. If you would like to report a privacy incident or concern, please click here.

Amendment Request
Privacy

Authorization to Release Health Information to Patient or Treating Provider (English)
Privacy

Authorization to Release Health Information to Patient or Treating Provider (Chinese)
Privacy

Authorization to Release Health Information to Patient or Treating Provider (Spanish)
Privacy

Authorization Revocation Request Form
Privacy

Care Everywhere & Health Information Exchange (HIE) form
Privacy

HIPAA Notice of Privacy Practices (NPP)- English
Privacy

Notice of Privacy Practices (NPP) Spanish
Privacy

Patient E-mail Communication Notice and Consent Form
Privacy

Submit Privacy Incident

Submit Compliance Incident

Weill Cornell Medicine Compliance & Privacy Office 575 Lexington Avenue, 9th Fl New York, NY 10022 Phone: (866)-293-3077