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 Disclosures Log
- Accounting of Disclosures Accounting of Disclosures
- Alternative Means Communication Alternative Means Communication
- Amendment PHI-HSC Amendment PHI-HSC
- Authorization Release Request Individuals Health Information Authorization Release Request Individuals Health Information
- Authorization Verbal Release PHI Authorization Verbal Release PHI
- Confidentiality Agreement Volunteers Visitors Confidentiality Agreement Volunteers Visitors
- Denial Individuals Request PHI Denial Individuals Request PHI
- Electronic Medical Record Usage Agreement for External Auditors Electronic Medical Record Usage Agreement for External Auditors
- Electronic Notice Of Privacy Practice Electronic Notice Of Privacy Practice
- Fax Cover Sheet Fax Cover Sheet
- HIPAA Privacy Complaint Report HIPAA Privacy Complaint Report
- Non Clinic Employee Role Non Clinic Employee Role
- PHI Amendment Notification Form PHI Amendment Notification Form
- Release To Law Enforcement Release To Law Enforcement
- Request for Restrictions Use Disclosures PHI Request for Restrictions Use Disclosures PHI
- Revocation of Request for Restrictions on Use and Disclosure of PHI Revocation of Request for Restrictions on Use and Disclosure of PHI
