The Document Templates section contains customizable sample documents such as a “Notice of Privacy Practices,” “Business Associate Agreement”, and “Authorization” forms. This also contains the “HIPAA Ready Reference” – a chart of typical day-to-day situations and the responses that are required to remain HIPAA compliant. This chart can be printed for your employees as a quick reference for what to do in these common situations. All Document Templates may be downloaded in Microsoft Word .DOC format and Adobe PDF format using the links below.
- Acknowledgement of Receipt of Notice
- Audit Checklist
- Authorization Form
- Breach Notification Notice
- Business Associate Log
- Business Associate Agreement
- Clearing House Survey Tool
- Complaint Form
- Copy Fee Matrix
- Confidential Channel Communication Request
- Disclosure Accounting Log
- ePHI Use and Disclosure Inventory
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- Form to use for situations when a covered entity like a hospital or medical practice makes their EHR available to another provider who is also treating the same patient.
- HIPAA Forms
- HIPAA EMR Checklist
- HIPAA Ready Reference
- HIPAA Transaction Rule Compliance
- Job Responsibilities with Respect to PHI
- Log of Policies and Procedures
- Notice of Privacy Practices
- Notice of Privacy Practices (Spanish Version)
- Notice of Privacy Practice CMA 8×14 Quad Fold
- OCR Security Audit Protocol
- OCR Privacy Audit Protocol
- OCR Breach Audit Protocol
- Payer Survey Tool
- PHI Use and Disclosure Inventory
- Privacy Incident Form
- Request for Access
- Request for Access to Inmate PHI
- Request for Amendment
- Request for Disclosure Accounting
- Request Health Plan Disclosure Restrictions
- Request Special Privacy Protections
- Risk Analysis Tracking Form
- Sample NPP cover letter
- Security Incident form
- Security Risk Management Template
- Spanish Acknowledgement
- Start the Security Walk Through
- TCS Survey Tool
- Tracking Accountable Disclosures Form
- Visitors sign in sheet
- Workforce Log for Physical Security Access
