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White – Health Information Management Department Yellow – Patient Page 1 of 2 Form # 7680-001 / 01.05 (Rev. 06/13/18) Authorization to Disclose Protected Health Information Instructions: Complete all applicable sections to have information disclosed from UT Southwestern Medical Center to another provider or requestor. UT Southwestern will not condition treatment, payment, enrollment or eligibility for benefits based on the completion of this form. Return form to: Mailing Address

Form # FMA/AARPOINTP-001 / 07.05 (Rev. 10.03.14) White – Health Information Management Department Yellow – Patient Reviewed 09/13 Authorization for Audio Recordings, Photography, or Other Images for Non-Treatment Purposes I hereby authorize the at (insert department name) UT Southwestern Medical Center to make audio recordings or to take photographs, videotape, or digital images of me (“Images”). I understand that  UT Southwestern may use and release my images to the general public for

Form # OCA/PCF-001 / 07.12 (Reviewed 09/13) Page 1 of 1 PRIVACY COMPLAINT FORM For Patient Use Only For Internal Use Only Tracking Number If you have questions about completing this form, please call 214-648-6080 and leave a message. Date Your First Name Your Last Name Home Phone ( ) Work Phone ( ) Address Apt. # City State Zip Date of Birth Are you filing this complaint for someone else? c Yes c No (if No, go to next section) If Yes, whose health

Form # FMA/RADI-001 / 03.03 (Rev. 08/15) (Reviewed 09/13) Page 1 of 1 You have the right to request that UT Southwestern Medical Center provide an accounting of certain disclosures of your protected health information. An accounting of disclosures may include disclosures up to 6 years prior to the date of the request. UT Southwestern Medical Center will respond to your request within 60 days of receipt of the request, unless you are notified in writing that a one-time extension of up

Neurocritical Care Leadership Venkatesh Aiyagari, M.D. Division Chief Contact Misti Marshall Section Administrator misti.marshall@utsouthwestern.edu The Division of Neurocritical Care is the largest in North Texas and brings together faculty from diverse disciplines including neurology, anesthesia, internal medicine, and radiology. The division embodies the core missions of the Department of Neurology, including excellence in patient care, promoting education, and advancing our understanding of

Autonomic Disorders Leadership Steven Vernino, M.D., Ph.D. Section Head Contact Alicia De Oliveira Lopes Academic Administrator alicia.deoliveiralopes@utsouthwestern.edu Patient Appointments 214-645-8800 Book Online The UT Southwestern Autonomic Disorders section is one of the academic leaders in the nation, specializing in this group of rare diseases that affect up to 6% of the population. Our core missions include excellence in patient care, promoting education, and advancing research. The

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Diabetic Limb Salvage Fellowship Diabetic Limb Salvage The Diabetic Limb Salvage Fellowship is centered around patient care, influencing every aspect of learning – from hands-on surgical techniques to critical thinking and clinical judgment. Innovative Wound Care Research We strive to advance wound care strategies and enhance patient outcomes. Our ambitious research encompasses novel techniques to revolutionize wound management and healing strategies. Fellows will engage and report on impactful

The mission of the Metabolomics Core Facility within Department of Biochemistry at the UT Southwestern is to assist investigators with their metabolomics projects.

Meet the Biomedical Engineering alumni.