<% username = request.form("username") %> <% usernumber = request.form("usernumber") %>

Health Insurance Portability & Accountability Act of 1996 (HIPAA)
Last Name:    
First Name:  
E-mail Address:    

Please verify that your information is correct before pressing Submit.

* Please use your entire university e-mail account (ex. name.#@osu.edu).  If you do not have an 'osu.edu' account, please use your primary e-mail account.

  Access to printable versions of the following documents: (Microsoft Word documents)

Notice of Privacy Practices (NPP) - HIPAA_NPP (pdf)

Acknowledgement of NPP - HIPAA_Acknowledgement_of_NPP (pdf)



For help regarding this page, please contact: Dr. Henry Fischbach (fischbach.3@osu.edu or 292-6983)