As of May 8, 2018

Updated with New Logo 09/01/18

Privacy and Security (Administration, Physical and Technical) Policies
Policies are listed in Alphabetical Order regardless of Number.

 A. Privacy

         Authorization for the Use and Disclosure of Protected Health Information PRI 101 (Updated 09/01/18)

     Form - Patient Authorization Form (Rev 09/18)
     Form - Revocation of Authorization (Rev 09/18)

Breach Notification Requirements for Protected Health Information PRI 117 (Updated 09/01/18)

Business Associates PRI102 (Updated 09/01/18)

Fundraising and Protected Health Information PRI114 (Updated 09/01/18)
      Form-  Record of Individual Who have Requested No Further Fundraising Communication (Rev 09/18) 

Marketing and Protected Health Information PRI 113 (Updated 09/01/18) 

     Form - Record of Individual No Further Marketing Communication (Rev 09/18)

Minimum Necessary Disclosures of PHI PRI110 (Updated 09/01/18)
        Form - Non-Treatment Related Disclosure of Entire Medical Records (Rev 09/18)

       Form - Routine and Recurring Disclosure of PHI Not Related to Treatment (Rev 09/18)

Minimum Necessary Requests for PHI PRI111 (Updated 09/01/18)

     FormNon Treatment Related Request of Medical Records (Rev 09/18)

     Form: Routine and Recurring Requests of PHI Not Related to Treatment (Rev 09/18)

Minimum Necessary Uses of PHI PRI109 (Updated 09/01/18)

Notice of Privacy Practices PRI100 (U08/31/09)

      Form - Notice of Privacy Practices for Patients (Rev 09/01/18)

       Form - Receipt of Notice of Privacy Practices (Rev 09/18)

 Patient Privacy Rights PRI103 (U08/31/09)

 Patient Requests for Access to Health Information for Inspection and/or Copying PRI106 (U08/31/09)

          FormRequest for Access to PHI Rev 09/18 

          Letter - Acceptance of Request for Access to PHI Rev 09/18 Contact Privacy Official

         Letter - Denial of Request for Access to PHI (Rev 09/18) Contact Privacy Official

 Patient Requests for Confidential Communications PRI105 (U08/31/09)

     FormPermission For Emai Communication (Rev 09/18)
     FormRequest for Confidential Communication (Rev 09/18)

Patient Requests for Restrictions on the Use and Disclosure of PHI  PRI104 (U08/31/09)
     FormRequest for Restrictions onUse/Disclosure of PHI (Rev 09/18)

Patient Requests to Amend Health Care Information PRI107 (U08/31/09)
     Letter - Acceptance to Request to Amend PHI (Re 09/18) Contact Privacy Official

     Letter - Denial of Request to Amend PHI (Rev 09/18) Contact Privacy Official

Privacy of the Heath Information of Deceased Patients PRI115 (U08/31/09)

Privacy Training for Staff and Volunteers PRI116 (U08/31/09)

Requests for an Accounting of Disclosures of Health Care Information PRI108 (U08/31/09)

Sanctions for Privacy Violations PRI112 (U08/31/09)

B. Security 

              1. Administrative

Business Associates SEC200 (U08/10)

Evaluation SEC201 (U08/10)

Information Access Management SEC 202 (U08/10)

Information System Activity Review SEC 207 (U08/10)

Password Management SEC 204 (R12/14)

Protection from Malicious Software SEC205(U11/10)

Risk Analysis SEC208 (U08/10)

Risk Management SEC209 (U08/10)

Sanction Policy SEC 210 (U11/10)

Security Awareness and Training SEC203 (U08/10)

Security Incidents SEC 206 (U08/10)

      Form: Risk Assessment Worksheet (Rev 09/18)

     Form: Security Incident Report (Rev 09/18)

     Form: Security Incident Report Log (Rev 09/18)

Workforce Security SEC 211 (U08/10)

    Form: Termination of Computer Access Checklist (Rev 09/18)

     2. Physical

Device and Media Control SEC212  (U11/10)

Facility Access Controls SEC 213 (U08/10)

Workstation Use and Workstation Security SEC214  (U11/10)

      Form - Guidelines for the Acceptable Use and Security of Workstation (Rev 09/18)

    3. Technical

Integrity of Electronic Protected Health Information  SEC216 (U11/10)

Person or Entity Authentication SEC 217 (U11/10)

Technical Access Control SEC215 (U11/10)

Transmission Security SEC218 (U11/10)