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Office of Legal Affairs
HIPAA Policy
The HIPAA Policy and other supporting documents are available in the following formats:
- HTML - Best for viewing on the web
- PDF - Best for printing *
*Requires Adobe Acrobat Reader.
Policies
Policy on Confidentiality and Security Access
-- HTML |
PDF
Fax Confidentiality and Security Policy
-- HTML | PDF
Confidentiality and Security Access Agreement
-- HTML | PDF
Requests and Authorizations
Authorization To Use Or Disclose Health
Information Pursuant To Health Insurance Portability and Accountability
Act of 1996 (HIPAA)
-- HTML | PDF
Request For Limitation and Restrictions Of Protected Health
Information
-- HTML | PDF
Request for an Accounting of Certain Disclosures of Protected
Health Information for Non-Treatment, payment, and Healthcare Operations
(TPO) Purposes
-- HTML | PDF
Request for Correction/Amendment of Protected Health Information
-- HTML | PDF
Request to Inspect and Copy Protected Health Information
-- HTML | PDF
Revocation of Authorization for Disclosure of Health Information
-- HTML | PDF
Forms
Statement Accompanying Disclosures
-- HTML | PDF