Acting in the best interests of all parties involved, the University of Alabama at Birmingham (UAB) and the UAB Health System and its entities require authorization and release forms for use when students, faculty, staff, patients and/or others are to be photographed or recorded in an individual or small-group setting – and/or when their likeness or comments from such a setting may be used in any way for the purpose of media, marketing, development, and/or customer service. Institutionally approved forms are found here; modification of the forms is not permitted except by authorized parties. There are two categories of forms to choose from: 1) Healthcare; and 2) Non-Healthcare. Please choose the appropriate form for use in your situation; it is the responsibility of the department to keep the signed forms on file, normally for a period of 36 months.

Healthcare

Please select one of the healthcare forms found in “UAB Standard for Photographing Patients.”

1. Attachment A – “Consent to Photograph, Videotape, Audiotape and/or Film.” This form should be used by the physicians/staff when they want to record in any way for educational/treatment purposes. This form should never apply to internal or external media.
2. Attachment B – “UABHS Authorization for Use/Disclosure of Information.” This form should be used when the intent is to disclose patient health information to the public for purposes of marketing/fundraising/etc. It should also be used by internal and external media when patients are being photographed/filmed/otherwise documented for purposes of advertisements, Web testimonials, etc.

Non-Healthcare

The “Media Release Form” should be used for all non-healthcare situations in which UAB faculty, staff, students and/or others are involved.