The following is a list of documents and forms that can be downloaded
by subscribers.
| Readiness Assessment Tools |
| • |
Path to Compliance Worksheet |
| • |
Readiness Assessment Checklist - Privacy |
| • |
Readiness Assessment Checklist - Security |
| • |
Software Functionality for Transaction Standards - Checklist |
| • |
Software Functionality for Privacy & Security - Checklist |
| • |
Request for Extension of Compliance Date for Transaction Standards |
Model Policies and Procedures |
| • |
Privacy Policies and Procedures |
| • |
Security Policies |
| • |
Supplement to Covered Entity Personnel Policies |
| • |
Policies
for Appropriate Use of Information Systems |
| • |
Staff Acknowledgement of Policies and Procedures |
| • |
Staff Training Program – Detailed Curriculum |
Individual Rights - Forms |
| • |
Notice of Privacy Practices |
| • |
Acknowledgement of Receipt of Notice of Privacy Practices |
| • |
Documentation of Provision of Notice of Privacy Practices |
| • |
Consent Form – General Use |
| • |
Authorization Form – General Use |
| • |
Consent/Authorization Form – Alcohol/Drug Abuse Program
|
| • |
Notice to accompany disclosure of alcohol/drug information |
| • |
Revocation of Consent |
| • |
Revocation of Authorization |
| • |
Request to Access Records |
| • |
Request to Amend Records |
| • |
Request of Confidential Communications |
| • |
Request for Restriction of Use and Disclosure of Protected Health
Information |
| • |
Request for an Accounting of Disclosures |
| • |
Response to Request by Individual – Thirty Day Extension
Letter |
| • |
Response Granting Request by Individual |
| • |
Response Denying Request for Access to Record |
| • |
Response Denying Request to Amend Record |
| • |
Complaint Form |
Business Associate Agreements |
| • |
Business
Associate Agreement – with Security Provisions |
| • |
Business
Associate Agreement – Alcohol/Drug Programs |
