HIPAA Policies and Forms

Policies

• Access of Individuals to Protected Health Information
  
  
• Accounting of Disclosures of Health Information
  
  
• Disclosures of Personally Identifiable Health Information to Business Associates
  
  
• Facsimile (Fax) Machine Transmittal of Confidential, Sensitive or Protected Health Information
  
  
• Notice of UMDNJ Privacy Practices for Protected Health Information (pdf)
  
  
• Protected Health Information - Destruction and Disposal
  
  
• Request for Amendment of Individual Health Information
  
  
• Requests for Restrictions of Uses and Disclosures of Protected Health Information
  
  
• Standards for Privacy of Individually Identifiable Health Information
  
  
• Uses and Disclosures of Health Information With and Without an Authorization

Forms

• - Request for Accounting of Disclosures of Protected Health Information Form (pdf)
  - Request for Accounting of Disclosures of Protected Health Information Form (.doc)
  
  
• - Request for Restriction of Health Information Form (pdf)
  - Request for Restriction of Health Information Form (.doc)
  
  
• - Request for Access to Protected Health Information Form (pdf)
  - Request for Access to Protected Health Information Form (.doc)
  
  
• - Authorization for Release Form (pdf)
  - Authorization for Release Form (.doc)
  
  
• - Request for Amendment of Health Information Form (pdf)
  - Request for Amendment of Health Information Form (.doc)
  
  
• - Business Associate Agreement Involving the Access to Protected Health Information (pdf)
  - Business Associate Agreement Involving the Access to Protected Health Information (.doc)
  
  
  
• - Limited Data Set Use Agreement (pdf)
• - Limited Data Set Use Agreement (.doc)