Important information and documentation for getting necessary authorization to capture and use photography or video and disclose medical information on the people you are photographing or recording.
Please read and be sure to understand all the information on this page regarding these important documents. In addition to these PDFs, access customizable Microsoft Word versions of model release forms below.
Model release forms must be obtained from people you are photographing or videotaping. These forms are required in order to grant an entity permission to use the subject's image and identifying information in any medium for educational, promotional, advertising, or other purposes. For public events, releases generally are not required if images do not focus on any individual; however, it is strongly encouraged that model releases are signed by all subjects if at all possible. One form is specifically for minors and must be completed by a parent or guardian. Your department/division, building and room, school, address, and phone numbers should be added at the top of the form on either the DOC or fillable PDF. To use the fillable PDF form, download Adobe Acrobat Reader for free. Links to instructions for completing a fillable form can be found below. Other content should not be modified in any way without the assistance of University Communications and Marketing.
As a health care provider, Rutgers must protect the privacy of patients and individuals disclosing health information. When capturing images or obtaining other personal health information from individuals, we are required under the Health Insurance Portability and Accountability Act (HIPAA) to obtain their permission to use the information or images by completing the HIPAA Authorization form. You must obtain a completed HIPAA Authorization for Use/Disclosure of Information and Consent/Use of Photographs and Audio/Video Images form from patients, patient legal representatives, and/or any individuals who disclose health information to you in any form (e.g., written, electronic, photographs, videos, reports, x-rays, lab results, and verbal) that you intend to use in communications vehicles (e.g., news releases, magazine stories, website content, brochures, advertisements, photos, videos, etc.). When photographing or videotaping individuals receiving services that are health related, you must obtain a HIPAA Authorization in lieu of a model release. For assistance on which form to use, please contact University Communications and Marketing.
Do not alter this form. If you require changes to it, seek assistance from University Communications and Marketing or the Rutgers Privacy Officer.