Please only attach documents necessary for the purposes of this case. Complete the entire form and check all that apply.This notice describes our privacy practices, which include how we may use, disclose, collect, handle, and protect our patients' PHI. Sample Forms These sample forms may be useful when filing documents for the civil and family courts. If you have any questions, consult an attorney. The Notice tells you about the ways UPMC may use and share your health information, as well as the legal duties we have about your health information. The purpose of this policy is to assure compliance with the new Pennsylvania. Reviewed a sample of County Disclosure of Interest Statements and Pennsylvania. Statement of Financial Interests forms for completeness and timely filing. That the application was not filed within the period specified in the official notice of the vacancy. d.