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HIPAA Privacy Tools


 Privacy Policies and Procedures

Privacy policies and procedures should embody the basic principles of confidentiality, integrity and availability.

 Privacy Resources

Privacy Policy Checklist (2004).pdfPrivacy Policy Checklist (2004)

 HIPAA Privacy Training Acknowledgment Forms

Providers, staff, students, trainees, etc., are required to complete HIPAA privacy and security training at the time of hire or appointment. To demonstrate that the training requirement is met, providers must complete appropriate documentation and retain these records with personnel training records.

 Training Resources

Education Privacy Training Acknowledgement Form (Associate, Student, Volunteer, Contractor).pdfEducation Privacy Training Acknowledgement Form (Associate, Student, Volunteer, Contractor)
HIPAA Training Acknowledgement Form (Staff) (2004).pdfHIPAA Training Acknowledgement Form (Staff) (2004)
HIPAA Training Acknowledgment Form for Video Training (Staff) (2004).pdfHIPAA Training Acknowledgment Form for Video Training (Staff) (2004)

 HIPAA Breach Notification

​Breach notification rules require the provider to furnish notice to affected individuals, HHS, and, sometimes, the media when there is a breach with respect to unsecured (e.g., unencrypted) health information.  If the breach occurs at or by the business associate, the business associate must provide notice to the covered entity.

 Breach Notification Resources

Breach Reporting Decision Tree.pdfBreach Reporting Decision Tree
Media Notification Statement.pdfMedia Notification Statement
Notification Letter for Affected Party.pdfNotification Letter for Affected Party
Step 1 - Privacy or Security Event Reporting Form.docStep 1 - Privacy or Security Event Reporting Form
This form can be used by staff to report potential privacy or security events for further investigation.
Step 2 - Potential Breach Report.docxStep 2 - Potential Breach Report
Privacy and Security Event Analysis – Potential Breach Investigation Template
​​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.