№ files_lp_4_process_3_089239
Authorization form establishing patient consent conditions for disclosure and transfer of medical and treatment records maintained by the University of Oklahoma, including provisions related to mental health information, substance use disorder records, and federal privacy regulations.
Organization: University of Oklahoma
Institution Type: University Health Services
Document Type: Authorization Form
Subject: Release of Health Information and Treatment Records
Legal Framework: HIPAA Privacy Rule; 42 CFR Part 2; 34 CFR Part 99 (FERPA)
Country: United States
State: Oklahoma
Responsible Office: University Privacy Official, University of Oklahoma Health Campus
Address: P. O. Box 26901, Oklahoma City, OK 73129
Record Types Covered: Health Records, Treatment Records, Billing Records, Immunization Records, X-ray Reports, Pathology/Lab Reports, Psychotherapy Notes, Substance Use Disorder Records
Purpose of Request Options: Referral, Legal, Transfer, Other
Expiration Policy: Authorization expires after the number of months specified by the patient (12 months if not entered)
Record Delivery Methods: Mail, Fax, Email, Recipient Pickup
Record Fee Policy: Paper copies $0.50 per page; digital copies $0.30 per page plus media cost; $5 per X-ray/film; $10 certification fee
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

Don’t have cryptocurrency yet?

You can still complete your purchase in a few minutes:
  1. Buy Crypto in a trusted app (Coinbase, Kraken, Cash App or any similar service).
  2. In the app, tap Send.
  3. Select network, paste our wallet address.
  4. Send the exact amount shown above.
After sending, paste your TXID (transaction ID) and your email to receive the download link. Need help? Contact support and we’ll guide you step by step.