Publicity/HIPAA release forms

A member of the public who is to be interviewed or photographed by the media or county staff must sign a publicity release if Multnomah County staff plan to publish the material or if county staff facilitates a reporter's access to that person.

The two-sided form allows members of the public to easily give their permission to speak to the media; and their permission to be compliant with the Health Insurance Portability and Accountability Act (HIPAA).

The form was created by the Communications Office, the Office of Multnomah County Attorney and the county's Privacy Officer.

To ensure that journalists and in-house materials respect the rights and privacy of our employees and the public, please read the following:

When the subject is a county employee

The Communications Office staff works with managers and employees to select willing volunteers for publicity and to guide the employee through the process. Employees do not need to sign a publicity release.

When the subject is a member of the public

For members of the public who also receive services from the Health Department, covered component areas of the Department of County Human Services or the covered component areas of the Department of Community Justice, they must sign both sides of the form.

Forms are available in English, Spanish, Russian, Vietnamese, Simplified Chinese, Somali, and Arabic.

Contact the Communications Office if a translator or interpreter is needed to assist other language speakers.