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Documents: Forms
  1. Model Form - Privacy Officer Job Description
  2. Model Form - Privacy Practices Assessment Tool
  3. Model Form - Notice of Privacy Practices
  4. Model Form - Written Acknowledgement of Receipt of Notice of Privacy Practices
  5. Model Form - Authorization to Use and/or Disclose Health Information
  6. Model Form - Business Associate Agreement
  7. Model Form - Request to Access Health Information
  8. Model Form - Request to Restrict Uses and/or Disclosures of Health Information
  9. Model Form - Request to Amend Health Information
  10. Model Form - Notice A - Notification of Agreement to Amend Health Information
  11. Model Form - Notice B - Notification of Denial to Amend Health Information
  12. Model Form - Notice C - Notification to Other Persons or Entities Regarding Agreement to Amend Health Information
  13. Model Form - Request to Restrict the Manner / Method of Confidential Communications
  14. Model Form - Request to Receive an Accounting of Disclosures
  15. Model Form - Accounting of Disclosures Record
  16. Model Form - Complaint Log
  17. Model Form - Confidentiality Agreement (optional form - for use with workforce members and other entities not considered to be business associates)
  18. Model Form - Security Gap Analysis Checklist
  19. Checklist of Essential Business Associate Relationships

Documents: Policies / Procedures
  1. List of Required Policies / Procedures Under HIPAA Privacy Regulation
  2. Model Form - Policy / Procedure regarding Notice of Privacy Practices
  3. Model Form - Policy / Procedure regarding Business Associates
  4. Model Form - Policy / Procedure regarding Minimum Necessary Requirement
  5. Model Form - Policy / Procedure regarding Use and/or Disclosure of Information Pursuant to an Authorization
  6. Model Form - Policy / Procedure regarding Verification of Identity and Authority of Individuals Seeking Health Information
  7. Model Form - Policy / Procedure regarding Use and/or Disclosure of Health Information for Purposes of Marketing
  8. Model Form - Policy / Procedure regarding Use and/or Disclosure of Health Information for Purposes of Fundraising
  9. Model Form - Policy / Procedure regarding Verbal Agreement to Use and/or Disclose Health Information in Provider Directory (optional form - not required if provider does not maintain patient directory; primarily for use by institutional providers)
  10. Model Form - Policy / Procedure regarding Verbal Agreement to Use and/or Disclose Health Information to Family Members and Friends
  11. Model Form - Policy / Procedure regarding Request to Access Health Information
  12. Model Form - Policy / Procedure regarding Request to Amend Health Information
  13. Model Form - Policy / Procedure regarding Request to Restrict Uses and/or Disclosures of Health Information
  14. Model Form - Policy / Procedure regarding Request to Restrict Manner / Method of Confidential Communications
  15. Model Form - Policy / Procedure regarding Request to Receive an Accounting of Disclosures
  16. Model Form - Policy / Procedure regarding De-identified Health Information & Limited Data Sets

Documents: Miscellaneous
  1. HIPAA Administrative Simplification Act - Timeline for Compliance
  2. Selected HIPAA Definitions



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