HIPAA Policies & Forms
The following is a compiled list of HIPAA Policies and Forms that are to be used by LDH employees. For more information and frequently asked questions regarding HIPAA, click here.
| POLICIES | |
| 17.1 | General Privacy Policy |
| 18.1 | Client Privacy Rights |
| 19.1 | Uses and Disclosure of Information |
| 20.1 | De-Identification of Information |
| 21.1 | Research Requests and Needs |
| 22.1 | Minimum Necessary Information |
| 23.1 | LDH Business Associates |
| 24.1 | Administrative, Technical and Physical Safeguards |
| 25.1 | Enforcement, Sanctions and Penalties |
| FORMS | |
| Form 101P | Notice of Privacy Practices |
| Form 102P | Acknowledgement of Receipt of NPP |
| Form 201P | Access to Records Request Form |
| Form 202P | 30-Day Extension to Respond to Access Request |
| Form 203P | Acceptance of Access to Records Request |
| Form 204P | Denial of Access to Records |
| Form 205P | Statement of Disagreement for Denial of Access to Health Information |
| Form 206P | Response to Statement of Disagreement to Access Records |
| Form 207P | Request for Review by the Program Privacy Officer for Denial of Access to Health Information |
| Form 301P | Amendment/Correction of Health Record Request Form |
| Form 302P | 30-Day Extension to Respond to Amendment Request |
| Form 303P | Acceptance of Amendment/Correction Request |
| Form 304P | Denial of Amendment/Correction Request |
| Form 305P | Statement of Disagreement for Denial of Amendment or Correction of Health Information |
| Form 306P | Response to Statement of Disagreement to Amend/Correct Health Information |
| Form 401P | Authorization to Release or Obtain Health Information for Eligibility in Program Enrollment |
| Form 402P | Authorization to Release or Obtain Health Information |
| Form 403P | Revocation of Authorization |
| Form 501P | Restriction of Use and Disclosure Request Form |
| Form 502P | 30-Day Extension to Respond to Restriction Request |
| Form 503P | Acceptance of Restriction Request |
| Form 504P | Denial of Restriction Request |
| Form 505P | Statement of Disagreement for Denial of Restriction Request |
| Form 506P | Response to Statement of Disagreement to Restriction Request |
| Form 601P | Privacy Complaint Report Form |
| Form 701P | Accounting of Disclosures Request Form |
| Form 702P | Accounting of Disclosures Tracking Form |
| Form 801P | Privacy Statement of Understanding |
| Business Associates Addendum |
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Business Associates Addendum to Purchasing Contracts or Purchase Orders |
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