HIPAA
Privacy Information
The university’s Health Plans are required by law to protect the privacy of your health information as described by the federal Health Insurance Portability and Accountability Act (HIPAA), give you a Notice of the Plans' legal duties and privacy practices, and follow the current Notice (below). All employees and volunteers of the university’s Health Plans will follow these regulations.
Health Plan Forms
- Accounting Disclosures Log
- Accounting of Disclosures
- Authorization Release/Request for an Individual's Health Information
- Authorization to Release Protected Health Information Verbally
- Confidentiality Agreement for Volunteers/Visitors
- Denial of Individual's Request for Protected Health Information
- Electronic Medical Record Usage Agreement for External Auditors
- Fax Cover Sheet- Protected Health Information
- HIPAA Complaint Report
- Non-Clinic Employee Role-Based Access Worksheet
- Release To Law Enforcement
- Request for Alternative Means of Communication
- Request for Amendment of Protected Health Information - Health Plan
- Request for Electronic Notice of Privacy Practices
- Request to Restrict Use and Disclosures of Protected Health Information
- Revocation of Request for Restrictions on Use and Disclosure of Protected Health Information
