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Prototype
HIPAA Policies - Table of Contents
(last revision March 1, 2004)
The
following list of policies and forms are in Adobe Acrobat format (PDF).
These files work best when viewed with Acrobat Reader 5.0, and may not load
properly
with
earlier versions of Acrobat Reader. To download a copy of the latest version
of the Acrobat reader, click here.
- Access of Individuals to Protected Health Information (39K
PDF)
FORM: Patient
Request to Access Protected Health
Information (62K PDF)
- Accounting
of Disclosures of Protected Health
Information (79K
PDF)
FORM: Request for Accounting of Disclosure (34K
PDF)
- Business
Associates (79K PDF)
FORM: Prototype Business Associate Agreement (64K
PDF)
FORM: Prototype
for Business Associate Addendum (57K PDF)
- Corrections
and Amendments to Record (79K PDF)
FORM: Request to Amend Health
Care Record (32K PDF)
- De-Identification
of Protected Health Information (66K PDF)
- Disclosure
of Protected health Information to Personal Representatives (75K
PDF)
- HIPAA-Protected
Records: Designated Record Set (71K
PDF)
- Notice
of Privacy Practices: Policy (84K PDF)
FORM: University of Iowa Privacy
Notice (70K PDF)
FORM: Privacy
Practice Acknowledgement Form (45K PDF)
- Privacy
Protection in Areas with Public Access (44K
PDF)
- Protected
Health Information Transferred to
Other Systems (30K
PDF)
- Request
for Confidential Communications (57K PDF)
FORM: Request for Confidential
Communications (33K PDF)
- Restrictions
on Use and Disclosure of Protected
Health Information (47K
PDF)
FORM: Request for Restricting
Use and Disclosure of Protected Health Information (34K
PDF)
- Use
and Disclosure of Protected Health Information (72K PDF)
- Verification
of Identity and Authority of Persons Requesting
Protected Health Information (71K
PDF)
- Violations
of Provisions of Privacy Rule (28K PDF)
- Acronyms (50K PDF)
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