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Authorizations for Use/Disclosure of Protected Health Information
Version: November 14, 2002—PRI.034.004
DWT Draft April 1, 2003
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Disclosures about Victims of Abuse or Neglect
Distributed at the January 9, 2002 HRC Quarterly Meeting
*FINAL* Version: December 4, 2002—PRI.006.005
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Disclosures for Cadaveric Organ Donation
*FINAL* Version: October 23, 2002—PRI.010.005
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Disclosures for Judicial and Administrative Proceedings
*FINAL* Version: February 12, 2003—PRI.003.006
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Disclosures for Public Health Activities
*FINAL* Version: September 2002—PRI.015.004
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Disclosures of Protected Health Information for Law Enforcement Purposes
Distributed at the January 9, 2002 HRC Quarterly Meeting
*FINAL* Version: October 24, 2002—PRI.009.005
•XPD Custody Form
•XPD Identification Form
•XPD Victims Form
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Disclosure of Protected Health Information for Workers' Compensation Programs
*FINAL* Version: May 7, 2003—PRI.017.003
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Disclosures to Business Associates
Version: January 2, 2002—PRI.007.004
DWT Draft April 1, 2003
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Facility Directories (Release of Directory Information to the General Public and the News Media)
*FINAL* Version: November 14, 2002—PRI.035.004
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Fundraising
*FINAL* Version: January 29, 2003—PRI.020.001
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Individual Right to Access and Obtain Copies of Protected Health Information
*FINAL* Version: January 29, 2003—PRI.004.003
•HIPAA Subpoena Authorization Form (pdf)
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Individual Right to File Complaints About Privacy Policies and Procedures or Compliance with Policies and Procedures
*FINAL* Version: November 14, 2002—PRI.024.002
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Individual Right to Request an Amendment to Protected Health Information
Version: February 20, 2002—PRI.001.007
DWT Draft April 1, 2003
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Notice of Privacy Practices
Version: November 14, 2002—PRI.037.002
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Patient's Right to an Accounting of Disclosures of Protected Health Information
*FINAL* Version: November 14, 2002—PRI.002.003
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Patient's Right to Request Confidential Communications Between (Facility Name) and the Patient
*FINAL* Version: November 14, 2002—PRI.041.003
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Patient's Right to Request Confidential Communications Restrictions on (Facility Name's) use Disclosure of Protected Health Information
Version: November 14, 2002—PRI.043.001
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Personal Representatives
*FINAL* Version: May 11, 2005—PRI.016.009
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Pre-Emption Analysis
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Sanctions for Breach of Security, Privacy, and Transaction Requirements
*FINAL* Version: August 10, 2005—PRI.025.004
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Uses and Disclosures for Health Oversight Activities
*FINAL* Version: October 9, 2002—PRI.018.004
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Uses and Disclosures for Involvement in the Individual's Care and Notification Purposes
*FINAL* Version: December 18, 2002—PRI.038.002
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Uses and Disclosures for Specialized Government Functions
*FINAL* Version: November 14, 2002—PRI.032.005
•RHI Active Military Personnel Form
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Uses and Disclosures of De-identified Health Information and Limited Data Sets
*FINAL* Version: December 14, 2002—PRI.033.004
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Uses and Disclosures of Protected Health Information for Educational Purposes
*FINAL* Version: June 4, 2003—PRI.044.008
•Student/Resident Confidentiality and Access Agreement Form
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Uses and Disclosures of Protected Health Information for Research Purposes
Version: November 14, 2002—PRI.013.001
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Uses and Disclosures of Protected Health Information of Decedents
*FINAL* Version: August 18 , 2004—PRI.005.006
•Request for Medical Records of Decedent - Non-Probate (Affidavit of Next-of-Kin)
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Uses and Disclosures to Avert a Serious Threat to Health or Safety
Distributed at the January 9, 2002 HRC Quarterly Meeting
*FINAL* Version: November 20, 2002—PRI.011.007
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Verification Procedures Prior to Disclosure of Protected Health Information
Version: November 14, 2002—PRI.014.005
- Workforce Training on the Use and Disclosure of Protected Health Information
*FINAL* Version: December 2, 2002—PRI.022.006