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HIPAA Privacy Tools

Disclaimer: These documents/forms and flow charts are presented as models only by way of illustration. They have not been reviewed by counsel. Before applying a particular form to a specific use by your organization, they should be reviewed by a counsel knowledgeable concerning federal and state privacy laws related to the use of medical records.

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Abstract
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collapse Category :  ‎(1)
HIPAA Reference Guide 2005.pdf
  
4598 KB
collapse Category : A. Business Associate Agreement ‎(4)
Decision Tree - When is the BA Agreement Required 2004.pdf
  
190 KB
Security Rule Amendment 2005.pdf
  
138 KB
HITECH Act Business Associate Agreement (BAA).pdf
  
34 KB
HITECH Act BAA Addendum.pdf
  
14 KB
collapse Category : B. Privacy Policies and Procedures ‎(2)
Privacy Policy Checklist 2004.pdf
  
49 KB
Privacy Regulations - HIPAA-Administrative Simplification_Internal Assessment 2004.pdf
  
333 KB
collapse Category : C. Sample HIPAA Privacy Training Acknowledgement Forms ‎(3)
Sample Acknowledgement of Privacy Training by Associates_Student_Volunteer_Contractor 2004.pdf
  
57 KB
Sample HIPAA Training Acknowledgement 2004.pdf
  
60 KB
Sample HIPAA Training Acknowledgement to Accompany Video_Mission-Confidential 2004.pdf
  
66 KB
collapse Category : D. Group Health Plan Information  ‎(2)
Group Health Plan - HIPAA Notice of Privacy Practices 2004.pdf
  
94 KB
Group Health Plan - HIPAA Summary Plan Description Addendum 2004.pdf
  
70 KB
collapse Category : E. Breach Notification ‎(6)
Breach Reporting Decision Tree.pdf
  
135 KB
Sample Media Notification Statement.pdf
  
22 KB
Sample Notification Letter for Affected Party.pdf
  
34 KB
Step 1 - Privacy or Security Event Reporting Form.doc
  
This form can be used by staff to report potential privacy or security events for further investigation.
121 KB
Step 2 - Privacy and Security Event Report Form.doc
  
Form used by Privacy/Security Officer to further investigate potential privacy/security events. Captures all info needed to report a breach to Dept of HHS as required by the federal Breach Notification for Unsecured Protected Hlth Info Interim Final Rule.
201 KB
Step 3 - Potential Breach Investigation Form.doc
  
This form can be used by the Privacy Officer to determine whether breach notification is required due to a privacy or security event. This form can be used in conjunction with the Breach Reporting Decision Tree.
143 KB
collapse Category : F. Miscellaneous  ‎(2)
HIPAA Privacy Rule Brochure 2004.pdf
  
570 KB
Frequently Asked Questions for Long Term Care 2004.pdf
  
130 KB
 

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