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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.
AbstractFilter
Expand/Collapse Category :  ‎(1)
HIPAA Reference Guide 2005.pdf
HIPAA Reference Guide 2005Use SHIFT+ENTER to open the menu (new window).
4597 KB
Expand/Collapse Category : A. Business Associate Agreement ‎(4)
Decision Tree - When is the BA Agreement Required 2004.pdf
Decision Tree - When is the BA Agreement Required 2004Use SHIFT+ENTER to open the menu (new window).
190 KB
Security Rule Amendment 2005.pdf
Security Rule Amendment 2005Use SHIFT+ENTER to open the menu (new window).
138 KB
HITECH Act Business Associate Agreement (BAA).pdf
HITECH Act Business Associate Agreement (BAA)Use SHIFT+ENTER to open the menu (new window).
34 KB
HITECH Act BAA Addendum.pdf
HITECH Act BAA AddendumUse SHIFT+ENTER to open the menu (new window).
14 KB
Expand/Collapse Category : B. Privacy Policies and Procedures ‎(2)
Privacy Policy Checklist 2004.pdf
Privacy Policy Checklist 2004Use SHIFT+ENTER to open the menu (new window).
49 KB
Privacy Regulations - HIPAA-Administrative Simplification_Internal Assessment 2004.pdf
Privacy Regulations - HIPAA-Administrative Simplification_Internal Assessment 2004Use SHIFT+ENTER to open the menu (new window).
333 KB
Expand/Collapse Category : C. Sample HIPAA Privacy Training Acknowledgement Forms ‎(3)
Sample Acknowledgement of Privacy Training by Associates_Student_Volunteer_Contractor 2004.pdf
Sample Acknowledgement of Privacy Training by Associates_Student_Volunteer_Contractor 2004Use SHIFT+ENTER to open the menu (new window).
56 KB
Sample HIPAA Training Acknowledgement 2004.pdf
Sample HIPAA Training Acknowledgement 2004Use SHIFT+ENTER to open the menu (new window).
60 KB
Sample HIPAA Training Acknowledgement to Accompany Video_Mission-Confidential 2004.pdf
Sample HIPAA Training Acknowledgement to Accompany Video_Mission-Confidential 2004Use SHIFT+ENTER to open the menu (new window).
66 KB
Expand/Collapse Category : D. Group Health Plan Information ‎(2)
Group Health Plan - HIPAA Notice of Privacy Practices 2004.pdf
Group Health Plan - HIPAA Notice of Privacy Practices 2004Use SHIFT+ENTER to open the menu (new window).
94 KB
Group Health Plan - HIPAA Summary Plan Description Addendum 2004.pdf
Group Health Plan - HIPAA Summary Plan Description Addendum 2004Use SHIFT+ENTER to open the menu (new window).
70 KB
Expand/Collapse Category : E. Breach Notification ‎(6)
Breach Reporting Decision Tree.pdf
Breach Reporting Decision TreeUse SHIFT+ENTER to open the menu (new window).
134 KB
Sample Media Notification Statement.pdf
Sample Media Notification StatementUse SHIFT+ENTER to open the menu (new window).
21 KB
Sample Notification Letter for Affected Party.pdf
Sample Notification Letter for Affected PartyUse SHIFT+ENTER to open the menu (new window).
33 KB
Step 1 - Privacy or Security Event Reporting Form.doc
Step 1 - Privacy or Security Event Reporting FormUse SHIFT+ENTER to open the menu (new window).
This form can be used by staff to report potential privacy or security events for further investigation.
118 KB
Step 2 - Privacy and Security Event Report Form.doc
Step 2 - Privacy and Security Event Report FormUse SHIFT+ENTER to open the menu (new window).
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.
198 KB
Step 3 - Potential Breach Investigation Form.doc
Step 3 - Potential Breach Investigation FormUse SHIFT+ENTER to open the menu (new window).
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.
140 KB
Expand/Collapse Category : F. Miscellaneous ‎(2)
HIPAA Privacy Rule Brochure 2004.pdf
HIPAA Privacy Rule Brochure 2004Use SHIFT+ENTER to open the menu (new window).
570 KB
Frequently Asked Questions for Long Term Care 2004.pdf
Frequently Asked Questions for Long Term Care 2004Use SHIFT+ENTER to open the menu (new window).
130 KB

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© 2012 American Health Care Association