Standard Document Templates

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  Document has been updated!

Audit Checklist  

Authorization Form  

Breach Notification Notice

Business Associate Agreement Standard

Business Associate Log

Complaint Form  Document has been updated!

Confidential Channel Communication Request  Document has been updated!

Disclosure Accounting Log  Document has been updated!

ePHI Use and Disclosure Inventory

Granting Remote Access Forms  Document has been updated!

  • 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 EMR Checklist

HIPAA Ready Reference

Job Responsibilities with Respect to PHI

Notice of Privacy Practice STD Quadfold 8×14  Document has been updated!

Notice of Privacy Practices  Document has been updated!

Notice of Privacy Practices (Spanish Version)  Document has been updated!

OCR Security Audit Protocol  Document has been updated!

OCR Privacy Audit Protocol  Document has been updated!

OCR Breach Audit Protocol  Document has been updated!

PHI Use and Disclosure Inventory

Privacy Incident Form  Document has been updated!

Request for Access  Document has been updated!

Request for Access to Inmate PHI  Document has been updated!

Request for Amendment  Document has been updated!

Request for Disclosure Accounting  Document has been updated!

Request Health Plan Disclosure Restrictions  Document has been updated!

Request Special Privacy Protections  Document has been updated!

Risk Analysis Tracking Form

Sample NPP cover letter  Document has been updated!

Security Incident form

Security Risk Management Template

Spanish Acknowledgement

Start the Security Walk Through

Visitors sign in sheet

Workforce Log for Physical Security Access


PrivaPlan Associates Privacy Policy


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