textHIPAA privacy regulations necessitate the use by covered entities of a range of standard documents and forms, including those for:

• notice of information/privacy practices and acknowledgement of receipt of that notice;

• authorizations for certain kinds of research, marketing, fundraising, etc.;

• requests for correction/amendment of health records;

• requests for additional protection of sensitive health information, or confidential communications.

So far, DHHS has not promulgated many model documents to assist covered entities in constructing such items. However, a growing number of other organizations have done so, and links to some of those materials are provided below:

• American College of Physician Executives, Model Notice of Information Practices (Adobe PDF, 7pp)
• American Health Information Management Association, Sample Request for Correction/Amendment of Health Information (HTML, with commentary, ~10pp)
• American Health Information Management Association, Sample Notice of Information Practices and Sample Acknowledgement of Receipt (HTML, with commentary, ~10pp)
• Physician's Practice, Inc., Model Patient Consent Form (MS Word, 1p)
• Physician's Practice, Inc., Model Authorization Form for Use and/or Disclosure of PHI (MS Word, 2pp)
• US Department of Health and Human Services, Sample Business Associate Contract (MS Word, 8pp)

Inclusion on the list does not constitute an endorsement of a particular model. Users must make their own determinations about which, if any, are most suitable to their circumstances.

See also:

• sample policies (HIPAA)

Last modified: 14-May-2005 [RC]