Patient forms

Myriad’s HIPAA Notice of Privacy Practices describes how your medical information may be used and disclosed and how you can get access to this information.

Patient Forms

These forms may be used by patient to exercise their rights as described in Myriad’s HIPAA Notice of Privacy Practices.

Authorization to Use and Disclose Protected Health Information – This form allows patient to request copies of their medical records, designate a new healthcare provider, and send medical records to individuals, entities, and healthcare providers other than those who ordered their tests.

Request for Amendments/Corrections to Medical Record – Patients may use this form to request certain amendments to their protected health information. Patients do not need to use this form to update address, phone or other contact information, and should contact Myriad’s Customer Service Department at 800-469-7423 to make these changes.

Request for Restrictions – Patients have the right to request certain restrictions on the ways in which Myriad uses and discloses their protected health information. This form is used to request restrictions.

Request for Confidential Communications – Patients can use this form to request that Myriad contact them using addresses or telephone numbers other than those which we have on file.

Request for Accounting of Disclosures – This form may be used to by patients to request an accounting of certain disclosures of their protected health information.

If you have questions or complaints about Myriad’s privacy practices please contact our Privacy Office:

ATTN: Privacy Office
320 Wakara Way
Salt Lake City, UT 84108
Email: [email protected]
Phone: 866-485-1599

Further Information about HIPAA please visit: http://www.hhs.gov/ocr/privacy/