TABLE OF CONTENTS

PREFACE

I.    GENERAL RULES

    •    Designated Record Set
    •    Minimum Necessary Uses and Disclosures of Protected Health Information
    •    Notice of Privacy Practices

Sample Form: Notice of Privacy Practices
Sample Form: Acknowledgment of Receipt of Notice of Privacy Practices

    •    Safeguarding and Storing Protected Health Information
    •    Emailing Protected Health Information
    •    Faxing Protected Health Information

Sample Form: Fax Cover Page

II.    USES AND DISCLOSURES

    •    Uses and Disclosures of Protected Health Information
    •    Authorization for Release of Protected Health Information
    •    Uses and Disclosures of Protected Health Information for Research

III.    RIGHTS OF PATIENTS

    •    Former Patients' Access to Protected Health Information

Sample Form: Access to Protected Health Information
Sample Form: Notification of Time Extension
Sample Form: Review Determination Letter

    •    Current Patients' Access to Protected Health Information
    •    Accounting of Disclosures of Protected Health Information

Sample Form: Request for an Accounting of Disclosures of Protected Health Information
Sample Form: Accounting of Disclosures of Protected Health Information

    •    Amendment of Protected Health Information

Sample Form: Amendment of Protected Health Information
Sample Form: Amendment Acceptance Letter
Sample Form: Amendment Acceptance with Consent to Notify Letter
Sample Form: Notification of Amendment Letter
Sample Form: Amendment Denial Letter

    •    Alternate Communications of Protected Health Information

Sample Form: Request to Restrict Use and Disclosure of Protected Health Information

    •    Complaints

Sample Form: Complaint Regarding Uses/Disclosures of Protected Health Information
Sample Form: Resolution of Complaint Regarding Uses/Disclosures of Protected Health Information
Sample Form: Log of Internal Complaints Regarding Privacy Issues

    •    Restrictions to Permitted Uses and Disclosures of Protected Health Information

Sample Form: Request to Restrict Use and Disclosure of Protected Health Information

IV.    OTHER REQUIREMENTS

    •    Business Associates
    •    De-Identification of Protected Health Information
    •    Marketing and Fundraising
    •    Responding to a Subpoena

Sample Form: Response to Subpoena Not Accompanied by Court Order and Lacking Satisfactory Assurance of Notice or Qualified Protective Order

    •    Sanctions
    •    Verification of Identity and Authority of Officials Requesting PHI

V.    HIPAA DOCUMENTATION

    •    Retention of Protected Health Information
    •    Destruction of Protected Health Information

VI.    GLOSSARY

 

---