HIPAA Compliance Forms

HIPAA COMPLIANCE FORMS

Form solutions that
make you confident that
you are in compliance
with HIPAA regulations.

The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996. The federal regulation includes mandates the set standards for protecting the privacy of medical and health information; now referred to as PROTECTED HEALTH INFORMATION (PHI). PHI is information that is maintained by healthcare entities, for example: hospitals, pharmacies, healthplans, dental practices, and private ptractices.

The deadline for compliance with the privacy standards is April 14, 2003 (small health plans have until April 14, 2004). To ensure compliance, healthcare entites will be required to document (forms) information captured a patients exercise their privacy rights.

TO DEVELOPE THE FORMS YOU CAN COUNT ON, WE CONSULTED WITH A HIPAA EXPERT!

Our HIPAA consultant has over 25 years experience in business management, practice management, financial and receivable management, and consulting in private practices, hospitals, and other healthcare entities. Our consultant has been educating healthcare entities on HIPAA compliance, and designed the forms listed below to help entities comply with the HIPAA Privacy Regulations.

Comply with the Federal HIPAA Privacy Regulations

Document and track information necessary to show that you are HIPAA compliant

Integrate easily with your existing medical record systems

Help simplify administrative processes

Ensure that patients privacy rights are not violated

NOTICE OF PRIVACY PRACTICES (includes acknowledgement)

Written Notice of Privacy Practices must be provided to patients on or before the first encounter and to other person upon request. The Notice notifies the patient of all uses and disclosures of his or her protected health information. In addition, this form has a removable label that provides practices with a written acknowledgement that the patient received the Privacy Notice, as required to be HIPAA compliant.

AUTHORIZATION TO RELEASE INFORMATION

Protected health information may be disclosed without written authorization only in the purpose specifically outlined in the Notice of Privacy Practice. All other uses and disclosures require this form which the patient fills out for authorization.

HIPAA EMPLOYEE TRAINING RECORD

A record of the HIPAA programs attended by the employee, number of hours attended, location, etc. Retain form in individual employees' personnel file.

HIPAA PRACTICE TRAINING RECORD

A record of each HIPAA education program you provide for employees. Includes title of program, number of hours, and attendees. Retain form in your HIPAA compliance Manual.

PATIENT REQUEST FOR ACCOUNTING OF DISCLOSURES

The patient who requests and "Accounting of Disclosures" will be asked to complete this form that requires the patient to provide the purpose of the request, the dates requestd, etc. The form, retained in the patient's medical record, also allows you to record the date you comply with the request.

PHI DISCLOSURE LOG

As required by HIPAA, you must track to whom disclosures of PHI are made. This form, retained in each patient's medical record, includes the pertinent information that should be recorded when disclosures are made. The form will be photocopied for patients who request as "Accounting of Disclosures."

PATIENT REQUEST TO INSPECT/REVIEW PHI

The patient who requests to inspect or review protected health information will be asked to complete this form that requires the patient to provide information regarding which information and/or dates are being requested. The form, retained in the patient's medical record, also allows you to record when and how the records are reviewed, if the review is denied, the reason for the denial and the denial notification date.

PATIENT REQUEST FOR RESTRICTIONS ON USE & DISCLOSURE OF PHI

The patient who requested that all or part of his PHI be restricted through use (within your practice) or through disclosure (to outside entities) will complete this form. The patient will provide specific information on WHAT he wants restricted and FROM WHOM. The form, retained in the patient's medical record, allows you to record when and how this request is granted, denied and/or terminated.

PHI ACCESS LOG

This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record:

PHI TRACKING LOG

This comprehensive log allows the practice to track the status of each request the patient may have made. It summarizes all forms that will be completed by the patient that are filed in the medical record: REQUEST TO INSPECT/COPY, REQUEST FOR RESTRICTIONS, REQUEST FOR CONFIDENTIAL COMMUNICATION, REQUEST FOR AMENDMENT, AND REQUEST FOR ACCOUNTING OF DISCLOSURES. The use of this log will eliminate the need to look through the entire record to determine if the patient has exercised any privacy rights. All information is on this one form.

PATIENT REQUEST FOR CONFIDENTIAL COMMUNICATIONS

The patient may request alternate means of communication. For example, a patient may request that they not be phone, at home or that mail be sent to an alternate address. In cases such as this, the patient will be asked to complete this form that requires the patient to outline specific communication requests.

PATIENT REQUEST FOR AMENDMENT OF HEALTH INFORMATION

The patient who request that an amendment be made to his record will be asked to complete this request. It contains all elements necessary for the provider to make a decision to grant or deny the request. The form is retained in the patient's medical record.

CHART LABELS TO IMPROVE EFFICIENCY!

These labels are designed to provide practices with an easy tool that will eliminate any confusion when it comes to HIPAA. Simply place these labels onto the patient chart, and quickly ALERTS and RESTRICTIONS.

Laser Sheet Labels, 10 labels per page, 250 labels per package. Actual size is 2" x 4"

NOTICE OF PRIVACY PRACTICE POSTER

We've put our entire Notice of Privacy Practice fomr onto an 11" x 17" Poster. Fits perfectly into a standard frame, and meets the HIPAA requirements of posting the Notice of Privacy Practice. (Actual poster is blue)

Southern California Computer Forms & Labels
P.O. Box 6229
Anaheim, California 92816-0229
Toll Free 800.224.7950
Local 714.637.6438
Fax 866.823.0751
info@inkoneverything.com