Forms for the YSM YouTube channel


Members of the YSM community who are producing video programs are welcome to submit them for inclusion on the YSM channel. The Office of Institutional Planning and Communications reviews submissions and approves videos for the YSM YouTube channel based on the criteria described on this site. The criteria areas are legal permissions, privacy under HIPAA, ownership of content, quality assurance, and metadata. We work with the Yale Broadcast and Media Center and the University Office of General Counsel to assure that quality and legal standards are met and with the Chief Privacy Officer to ensure compliance with HIPAA.

Speaker's Permission Form

We confirm with you that the major speakers (or lecturer) in the video have signed the Yale Speaker’s Permission Form. This includes Yale faculty, students, and staff. We cannot distribute the content without this permission. We cannot post a video online till the speaker has signed this form. If the speaker has questions or concerns about the form, please alert us, and we can connect them with Yale’s Office of General Counsel (OGC). 

The speakers can return this form to your office, and you can fax a copy to our office at (203) 785-4327. If it is a scanned image, please forward the form to Michael Fitzsousa at If the speaker has already signed a permissions form for this video that is not the Yale Speaker’s Permission form, you can forward that to our office and we can review with OGC that it is acceptable. 

Download the Speaker's Permission form here: PDF 

HIPAA Permission Form (Patient Privacy)

Yale University is committed to respecting patients' and clinical research subjects’ rights to maintain the privacy of their health information and ensuring appropriate security of all protected health information. The standards for protecting patient health information are described in the federal law known as the Health Insurance Portability and Accountability Act (HIPAA). 

Before publishing any article, photograph, video, or audio program containing a Yale patient’s protected information, we must have signed permission from the patient.

Download the HIPAA permission form here. PDF

Copyrighted Media

If a video contains copyrighted imagery (photos, clip art, graphs, etc.) or other media (videos, music tracks, etc.) we must confirm with you that Yale has permission to disseminate this content. Permission must be granted by the content originator to allow Yale to distribute the content on any and all dissemination platforms.