LINKS:

• HIPAA Release Form
  (use with patients)

• General Photo & Video Release Form
  (for use if no PHI is involved)

• Media Release Forms on MyYSM

• If you just want to email a scanned file, send it to s_medcomm_hipaa_form@yale.edu

SHORT INSTRUCTIONS for HIPAA MEDIA RELEASE:

DETAILED INSTRUCTIONS for HIPAA MEDIA RELEASE:

Before you have a Patient, You Need to get Set Up

Step 1 – Download Adobe Sign to Your Computer

Find the Adobe Sign Enterprise service on Yale’s OnTheHub Web Store here. Or, visit the OnTheHub Web Store and type Adobe Sign Enterprise Service into the Search bar and click the blue Start Shopping button.

Step 2 - Add to Cart

Add the service to your cart, then click the shopping cart icon and follow the directions. Choose “I am placing this order for myself” and then Check out. There is nothing for you to install.

Please note that this service requires an annual subscription renewal, which can be done via the Web Store. The Web Store vendor will send out a reminder with a 7-day grace period to renew your subscription.

 Step 3 - Authenticate to Use the Service

Once you have successfully authenticated to the service, please email ysm.editor@yale.edu to give you access to the HIPAA Media Release Form tool.

For more Adobe Sign information, please see the Digital Signatures: Adobe Acrobat Sign Enterprise Quick Guide (KB0025674)

When You Have a Patient on a Shoot

 Step 0: Ask the patient if they can log into Adobe

The patient will have to log into Adobe with one of these things: their email address, their facebook acount, their google account, their microsoft account, or their apple account. All of those can be accomplished at this link: https://auth.services.adobe.com/en_US/deeplink.html#/

More instructions for how to register your email address with Adobe are here: https://helpx.adobe.com/manage-account/using/create-update-adobe-id.html

Step 1 - You, the employee, Log in to Adobe Sign

Log in to Adobe Acrobat Sign here using your Yale email address, and CAS with your NetID. You may be asked to choose Company/School Account.

Step 2 - The Adobe Sign Homepage

One you’re brought to the main Adobe Sign homepage, click the Start from Library button and this will create a new document. If you do not see “Start from Library” you need to email ysm.editor@yale.edu so we can give you access.

The Start from library modal will appear and you will see two templates available to you: English or Spanish. Click on the one you want to use, then click on the blue Start button to open it.

Step 3 - Build out the Document

Type in the patient’s email address (do not type in your Yale email address).

This is generating the email to send to the patient, and all should default ready to go. You can change any text if you want to, but it is not necessary.

The name of the template (i.e., ENGLISH: YNHH-Yale HIPAA Authorization Release) automatically defaults as the Message Title. The “Please review and complete ENGLISH: YNHH-Yale HIPAA Authorization Release” text also defaults within the body of the Message.

You can also see the document name appear under Files*. You will be able to attach more files to your email if needed.

Make sure that the gray Preview & Add Signatures Fields box is checked.

When ready, click the blue Next button at the bottom of the page.

Step 4 - Process and Prepare the Document

When you click Next, the system will then process the document. There is nothing to do at this step except click the blue Send button at the bottom of the right-hand column when ready.

Now the PDF document will load. The yellow boxes are for you to fill in our office information as needed.

Step 5 - Notification that the Document has been Sent

After hitting Send, you’ll see on your screen that the form has been successfully sent out for signature (you’ll also receive the same message in your Outlook inbox).

You can be alerted by Adobe Sign if the Recipient has not viewed, and/or signed, the document within a certain amount of time after it’s been sent. You can edit this by clicking on the blue Change alert settings text.

Step 6 - The Recipient Receives and Completes the Form

The Patient will receive an email in their inbox. The “From” will read as: Adobe Acrobat Sign on behalf of (your name). The “subject line” will be: Signature Required on HIPAA Authorization.

The patient will have to have registered their email address with Adobe, and/or use their facebook, microsoft, apple, or google account to log in to adobe. This is how we verify they are who they say they are. Instructions are here: https://helpx.adobe.com/manage-account/using/create-update-adobe-id.html

If a patient can’t or won’t create the Adobe account, they can print off a copy of the pdf release, sign it, and send us a photo of the signed form which we can then put in our central file by sending to this email address: s_medcomm_hipaa_form@yale.edu

When the Recipient opens the form, the system will direct them on where to fill in information. They will be asked to add their name, mailing address, city, state, zip code and phone number. In between each text box, the patient will need to click the Next button on the left.

The Recipient of your email will also have the option to click the circle next to “I am the Patient/Participant” or “I am the Parent/Legal Guardian/Personal Representative (if under 18 or incapable of signing).”

Towards the bottom of the form, the Recipient will be asked to add a signature. They’ll be given the choice to type it in, draw it, add an image, or use their mobile device.

Step 7 - Filing the Document

Once the Recipient clicks the blue Apply button, as the Sender, you’ll receive an email in your Outlook inbox confirming that the form has been signed and filed.

You can view the document in your Adobe Acrobat Sign account if you go to Manage in the top Navigation and then to Completed. Or, you can also find it in the HIPAA Media Release Forms Teams account under the date it was signed.

Instructions for General Photo & Video Release (not HIPAA)

1. Visit General Photo & Video Release Form and have subject fill out the form. An email copy will be sent to [HIPAA Media Release Forms] .