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 photographed or recorded in an individual or small-group setting to be be used for the purpose of media, marketing, development and/or customer service.
Institutionally approved forms are below; modification of the forms is not permitted except by authorized parties. There are two categories of forms to choose from: 1) Health care; and 2) Non health care. It is the responsibility of the department to keep the signed forms on file, normally for a period of 36 months.
Please select one of the health-care forms found in “UAB Standard for Photographing Patients.”
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.
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 be used by internal and external media when patients are being photographed/filmed/otherwise documented for purposes of advertisements, Web testimonials, etc.
The “Media Release Form” should be used for all non-health-care situations in which UAB faculty, staff, students or others are involved.