Media Release Forms

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style="stroke-linecap:round;stroke-linejoin:round;fill:currentColor;stroke-width:.25px;stroke-opacity:1"></path></svg></button></li></ul></div><div><div class="generic-paragraph"><div class="heading__container"><h2 class="generic-paragraph__heading" id="hipaa-media-release-form">HIPAA Media Release Form</h2><div class="heading__anchor-copy-button-container"><button type="button" aria-label="Copy Link" class="anchor-copy-button anchor-copy-button--color-mode--dark"><span class="anchor-copy-button__content"><span class="anchor-copy-button__text">Copy Link</span><svg xmlns="http://www.w3.org/2000/svg" xml:space="preserve" viewBox="0 0 24 24" focusable="false" class="anchor-copy-button__icon"><path d="M5.253 21.497a5.21 5.21 0 0 1-3.712-1.535A5.21 5.21 0 0 1 .006 16.25c0-1.404.545-2.722 1.535-3.712l4.773-4.774a5.22 5.22 0 0 1 3.716-1.539c1.402 0 2.719.544 3.708 1.531a5.225 5.225 0 0 1 .538 6.804.75.75 0 0 1-1.048.165.74.74 0 0 1-.299-.489.75.75 0 0 1 .134-.558 3.73 3.73 0 0 0-.384-4.86 3.73 3.73 0 0 0-2.649-1.094 3.73 3.73 0 0 0-2.655 1.099l-4.774 4.774a3.754 3.754 0 0 0 0 5.303c.707.707 1.649 1.096 2.652 1.096s1.945-.389 2.652-1.096l.932-.932a.744.744 0 0 1 1.06 0 .744.744 0 0 1 0 1.06l-.932.932a5.2 5.2 0 0 1-3.712 1.537"></path><path d="M13.978 18.024a5.21 5.21 0 0 1-3.709-1.535 5.22 5.22 0 0 1-.536-6.803.75.75 0 0 1 1.047-.166.75.75 0 0 1 .3.49.75.75 0 0 1-.134.558 3.73 3.73 0 0 0 .383 4.859 3.73 3.73 0 0 0 2.65 1.096 3.73 3.73 0 0 0 2.654-1.1l4.773-4.773c.708-.708 1.098-1.65 1.098-2.652s-.39-1.943-1.098-2.652c-.707-.707-1.649-1.096-2.652-1.096s-1.945.389-2.652 1.096l-.75.75a.744.744 0 0 1-1.06 0c-.142-.141-.22-.33-.22-.53s.078-.389.22-.53l.75-.75c.99-.99 2.309-1.536 3.712-1.536s2.722.545 3.712 1.536a5.21 5.21 0 0 1 1.538 3.712 5.21 5.21 0 0 1-1.538 3.712l-4.773 4.773a5.21 5.21 0 0 1-3.711 1.54z"></path></svg></span></button></div></div><div class="generic-paragraph__text"><p>The HIPAA Media Release Form is used anytime you will involve a patient or PHI in an article, photography, or video. <br></p> <ul> <li> <a href="http://m.yale.edu/hipaa-release/">Digital HIPAA Media Release Form <br></a> </li> <li> <a href="https://ysmweb.atlassian.net/wiki/spaces/HELP/pages/2724855809/New+Photo+Video+Media+Releases+Instructions+m.yale.edu+releases">Instructions for the Digital HIPAA Media Release Form </a> </li> <li> <a href="https://m.yale.edu/hipaa-release-pdf">PDF HIPAA Media Release Form</a> </li> </ul> <p> <br> </p></div></div></div> </section></div><div class="component-wrapper component-wrapper--all"><section class="video video--large" aria-label=""Instructions for the YSM HIPAA Media Release Form Tool" video"><div class="video__wrapper"><figure class="video-player"><figure class="poster poster--width-mode--auto"><span class="" style="display:inline-block"></span><div class="poster__details"><button type="button" aria-label="Play "Instructions for the YSM HIPAA Media Release Form Tool" video" class="poster__play-button-container"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" focusable="false" class="poster__play-button"><circle cx="12" cy="11.998" r="11.25" style="fill:none;stroke:currentColor;stroke-linecap:round;stroke-linejoin:round;stroke-width:1.5px"></circle><path d="M9 15.613a1.636 1.636 0 0 0 2.712 1.231L17.25 12l-5.538-4.847A1.635 1.635 0 0 0 9 8.384Z" style="fill:none;stroke:currentColor;stroke-linecap:round;stroke-linejoin:round;stroke-width:1.5px"></path></svg></button><div class="poster__caption-container"><p class="poster__duration">00:04:13</p><h2 class="poster__title">Instructions for the YSM HIPAA Media Release Form Tool</h2><div class="LinesEllipsis text-overflow poster__caption"><div><ul><li><strong>First:</strong> Get <a data-testid="link-with-safety" href="https://yale.onthehub.com/WebStore/OfferingDetails.aspx?o=5b460197-00f3-ec11-814a-000d3af41938&pmv=00000000-0000-0000-0000-000000000000" title="https://yale.onthehub.com/WebStore/OfferingDetails.aspx?o=5b460197-00f3-ec11-814a-000d3af41938&pmv=00000000-0000-0000-0000-000000000000" data-renderer-mark="true">Adobe Sign</a> and email ysm.editor@yale.edu to request access to the HIPAA tool.</li><li><strong>Then:</strong> Prepare a file via <a data-testid="link-with-safety" href="http://m.yale.edu/hipaa-release/" title="http://m.yale.edu/hipaa-release/" data-renderer-mark="true"><strong>HIPAA Release Form</strong></a></li></ul></div></div></div></div></figure></figure></div></section></div><div class="component-wrapper component-wrapper--all"><section class="generic-content" aria-label="General Photo/Video Release form"><div class="generic-content__title-container"><div class="heading__container"><h2 id="general-photo-video-release-form" class="generic-content__title">General Photo/Video Release form</h2><div class="heading__anchor-copy-button-container"><button type="button" aria-label="Copy Link" class="anchor-copy-button anchor-copy-button--color-mode--dark"><span class="anchor-copy-button__content"><span class="anchor-copy-button__text">Copy Link</span><svg xmlns="http://www.w3.org/2000/svg" xml:space="preserve" viewBox="0 0 24 24" focusable="false" class="anchor-copy-button__icon"><path d="M5.253 21.497a5.21 5.21 0 0 1-3.712-1.535A5.21 5.21 0 0 1 .006 16.25c0-1.404.545-2.722 1.535-3.712l4.773-4.774a5.22 5.22 0 0 1 3.716-1.539c1.402 0 2.719.544 3.708 1.531a5.225 5.225 0 0 1 .538 6.804.75.75 0 0 1-1.048.165.74.74 0 0 1-.299-.489.75.75 0 0 1 .134-.558 3.73 3.73 0 0 0-.384-4.86 3.73 3.73 0 0 0-2.649-1.094 3.73 3.73 0 0 0-2.655 1.099l-4.774 4.774a3.754 3.754 0 0 0 0 5.303c.707.707 1.649 1.096 2.652 1.096s1.945-.389 2.652-1.096l.932-.932a.744.744 0 0 1 1.06 0 .744.744 0 0 1 0 1.06l-.932.932a5.2 5.2 0 0 1-3.712 1.537"></path><path d="M13.978 18.024a5.21 5.21 0 0 1-3.709-1.535 5.22 5.22 0 0 1-.536-6.803.75.75 0 0 1 1.047-.166.75.75 0 0 1 .3.49.75.75 0 0 1-.134.558 3.73 3.73 0 0 0 .383 4.859 3.73 3.73 0 0 0 2.65 1.096 3.73 3.73 0 0 0 2.654-1.1l4.773-4.773c.708-.708 1.098-1.65 1.098-2.652s-.39-1.943-1.098-2.652c-.707-.707-1.649-1.096-2.652-1.096s-1.945.389-2.652 1.096l-.75.75a.744.744 0 0 1-1.06 0c-.142-.141-.22-.33-.22-.53s.078-.389.22-.53l.75-.75c.99-.99 2.309-1.536 3.712-1.536s2.722.545 3.712 1.536a5.21 5.21 0 0 1 1.538 3.712 5.21 5.21 0 0 1-1.538 3.712l-4.773 4.773a5.21 5.21 0 0 1-3.711 1.54z"></path></svg></span></button></div></div></div><div><div class="generic-paragraph"><div class="generic-paragraph__text"><p>The General Release form can be used when the shoot is not clinical and there is no PHI involved. For instance, you might use this form if you are taking photographs of a gathering and you want to have release forms for the visitors who were included in the photograph.</p> <ul> <li> <a href="https://yalesurvey.ca1.qualtrics.com/jfe/form/SV_6JXNDZEIUigItam">Digital General Release Form</a> </li> <li> <a title="YSM General Photo-Video Release" href="https://files-profile.medicine.yale.edu/documents/b6a2526b-bc5b-4257-9524-0c9a071d9b67">PDF General Release Form</a> </li> </ul></div></div></div> </section></div></div><div class="sidebar page__sidebar-container"><div class="sidebar__sticky-container"></div></div></main><footer class="footer"><div class="footer__primary-panel-wrapper footer__primary-panel-wrapper--full-height"><div class="footer__content-container"><section class="footer__primary-panel" aria-label="Primary Links"><div class="desktop-footer-primary-panel"><div class="desktop-footer-primary-panel__organization-info-wrapper"><div class="footer-organization-info" 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