Personalized Administrative Support Forms

Your patients have the right to request special handling of their Protected Health Information, including specifying where and how you may communicate with them. Our unique Support Forms provide guidance for the patient making a special request (relieving the Staff of that burden) and provide relevant HIPAA regulations. This gives the staff clear guidelines for making determinations on patients’ special handling requests, and apprises the patient of the nature and limits of the rights they are exercising.

Form Key	Form Name (click name to view form)	Quantity *
D	Confidential Communications Request	100
E	PHI Disclosure Restrictions/Termination	50
G	Patient Request For PHI Access	100
H	PHI Release Authorization	50 **
I	PHI Disclosure Determination Worksheet	100
J	PHI Disclosure Accounting Log	50
K	Request For PHI Disclosure Accounting	50
L	Request To Amend PHI	50
M	Response To Patient’s Req. To Amend PHI	50 **
N	Patient’s Statement of Disagreement	50
O	Notice of Amendment to Patient's PHI	50 **
P	Notice of Patient Privacy Complaint	50
Q	Privacy Complaint Investigation	50
R	Response to Patient Privacy Complaint	50 **
S	Privacy Memorandum	50 **
T	Request to verify Recipient/Secure Fax	50
U	Fax Cover Sheet	50

* Quantities are doubled in the Largest (2500 patient) Deluxe Kit

** Two-part NCR carbonless form.

The Support Forms help you comply with your HIPAA responsibilities. Below, we explain your responsibilities and then we explain how the Support Forms make it simpler for the whole staff to comply with those responsibilities.

Your Responsibilities

HIPAA clearly outlines your patients' privacy rights and places serious responsibility on the staff of a medical practice.

• You are required to document any requests the patient may make regarding such matters as limiting access to their protected (personal) health information (PHI) and even limiting conditions under which you may communicate with them,

• You must comply with those requests or thoroughly document your reasons for not complying – and then thoroughly document appeals to your decision made by the patient,

• You are required to document patients' complaints on privacy practices, and then document investigations and responses into those complaints.

• You must document certain types of disclosures (and provide accountings of those disclosures both by the Practice and by its business associates)

• You need to document the protocols and procedures that you use to protect the patient’s PHI.

How We Help You Comply

HIPAAeasy's personalized administrative support forms help bring order and uniformity to the execution of these actions. When you purchase one of our HIPAAeasy kits you will get supplies of all these forms. You may not need each of these forms every day but when you do need them you will have them at your fingertips.

• They save time. If a patient has a special privacy need you could just hand them a blank piece of paper and devote staff time to walking them through the request process – if your staff has the time for such things, and if they are experts in HIPAA. With HIPAAeasy’s forms most patients who wish to exercise special privacy rights can just fill out the appropriate form. The Doctor and the Privacy Officer won’t have to waste any time deciphering hand written requests. The possibility of misunderstandings is reduced at every stage.

• Another way they save time: HIPAAeasy’s support forms contain a thorough reference to the HIPAA regulations relevant to the form. This gives the staff clear guidelines for making determinations on patients’ special handling requests. This will save many time-consuming trips to the office policy manual, and/or prevent mishandling these requests. Importantly, by having the relevant regulations right on the form, the patient will also be informed of the nature and limits of the rights they are exercising. (Certain forms are convenient two-part carbonless NCR forms so that, where mandated by HIPAA, the patient can have a copy.)

In essence, these are the forms that are required to carry out your patient's privacy rights and protections. HIPAAeasy’s Administrative Support Forms work hand-in-glove with the HIPAAeasy Chart Labels. When a patient requests special handling of their PHI, their chart folder receives the Red Chart Label, so that your staff is alerted to look inside the folder to ascertain the nature of the patient’s request and the actions they must take to comply with it.

Some forms need to be multipart because the patient or another recipient must get a copy. Where that is necessary, the document is printed on a two-part NCR carbonless form. All forms are serialized for tracking.

We can help you decide WHICH KIT and quantities are right for your practice.

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