UW Medicine Compliance

Patient Privacy Policies Resources

Table of Contents | Privacy Policies Summary | Compliance Policies Map

 

Category # Title
GUIDANCE Patient Information Privacy Policies – Table of Contents
101 Patient Information Privacy and Security Compliance Program and Administrative Requirements
POLICY COMP.101 Patient Information Privacy and Security Compliance Program and Administrative Requirements
101 Guidance
GUIDANCE 101.G1 University of Washington HIPAA Designation
GUIDANCE 101.G2 Privacy Policies Summary
102 Safeguarding the Privacy and Security of Protected Health Information
POLICY COMP.102 Safeguarding the Privacy and Security of Protected Health Information (PHI)
102 Forms
FORM 102.F1 Agreement for Electronic Access to Protected Health Information
FORM 102.F2 Workforce Member Documentation of IT System Access
FORM 102.F3 Non-UW Medicine Workforce Privacy, Confidentiality and Information Security Agreement
102 Guidance
GUIDANCE 102.G1 Use and Disclosure of Protected Health Information (PHI) in Patient Audio/Video Recordings, Photographs, & Digital Images
GUIDANCE 102.G2 Faxing PHI
GUIDANCE 102.G3 Use and Disclosure of Protected Health Information (PHI) for Patient Appointment Reminders and Other Types of Messages
GUIDANCE 102.G4 Protected Health Information (PHI)
103 Use and Disclosure of Protected Health Information
POLICY COMP.103 Use and Disclosure of Protected Health Information
103 Forms
FORM 103.F1 Mandatory Violent Injury Report (UH2883)
(VMC, see here)
FORM 103.F2 Release of Patient Property Form
FORM 103.F3 Law Enforcement Request for Information (UH2884)
(VMC, see here)
FORM 103.F4 Patient Information for Inclusion in the UW Medicine Patient Directory (UH1868)
(VMC, see here)
FORM 103.F5 UW Medicine Request for Minor Proxy eCare Access (UH3293)
(VMC, see here)
FORM 103.F6 UW Medicine Request for Adult Proxy eCare Access (UH3292)
(VMC, see here)
FORM 103.F7 Patient Authorization to Disclose, Release and/or Obtain Protected Health Information Form (UH0626)
(VMC, see here)
FORM 103.F8 Release of Information Coordination and Action Form
FORM 103.F9 Verbal Redisclosure (Record of verbal Redisclosure of PHI) (UH1866)
(VMC, see here)
FORM 103.F10 Patient Authorization to Use & Disclose Protected Health Information for Publication(UH3031)
(VMC, see here)
FORM 103.F11 Patient Authorization to Use or Disclose Photography/Video Tape Form(UH0324)
(VMC, see here)
FORM 103.F12 Patient Authorization for UW Medicine to Use or Disclose Protected Health Information for Publicity Form (UH1874)
(VMC, see here)
103 Guidance
GUIDANCE 103.G1 Treatment, Payment and Healthcare Operations
GUIDANCE 103.G2 Minimum Necessary Disclosure Decision Tree
GUIDANCE 103.G3 Law Enforcement Requests Disclosure of Patient Information
GUIDANCE 103.G4 Minor (Parent/Guardian) eCare Account Request Process
GUIDANCE 103.G5 Adult/Proxy eCare Account Request Process
GUIDANCE 103.G6 Deactivation of eCare Proxy Access
GUIDANCE 103.G7 Prohibition on Redisclosure
GUIDANCE 103.G8 Release of PHI for Judicial and Administrative proceedings
GUIDANCE 103.G9 Marketing Activities Guidance
GUIDANCE 103.G10 Use & Disclosure of PHI for Involvement in Patient’s Care and Notification Decision Tree
103 Templates
TEMPLATE 103.T1 Sample Letter: Subpoena Unenforceable
TEMPLATE 103.T2 Sample Letter: Subpoena Rejection
TEMPLATE 103.T3 Sample Letter: Rejection Out of State Subpoena
TEMPLATE 103.T4 Sample Letter: PHI – Incomplete Request
TEMPLATE 103.T5 Sample Letter: UW Medicine Authorization to Disclose PHI Status Update Letter to Patient
TEMPLATE 103.T6 Data Use Agreement for Limited Data Set (for individuals or entities NOT part of UW Medicine workforce)
TEMPLATE 103.T7 Data Use Agreement for Limited Data Set for UW Medicine workforce
104 Patient Rights Related to Protected Health Information
POLICY COMP.104 Patient Rights Related to Protected Health Information (PHI)
104 Forms
FORM 104.F1 UW Medicine Joint Notice of Privacy Practices (Brochure) (UH1858)
(http://www.uwmedicine.org/nopp).
FORM 104.F2 UW Medicine Joint Notice of Privacy Practices (Text Version)
FORM 104.F3 Translation NoPP: Arabic
FORM 104.F4 Translation NoPP: Chinese
FORM 104.F5 Translation NoPP: Russian
FORM 104.F6 Translation NoPP: Somali
FORM 104.F7 Translation NoPP: Spanish
FORM 104.F8 Translation NoPP: Vietnamese
FORM 104.F9 Notice of Privacy Practices Acknowledgment Form (UH2045)
(VMC, see here)
FORM 104.F10 Request to Consider Additional Privacy Protection for Protected Health Information (UH1869)
(VMC, see here)
FORM 104.F11 Request to Restrict Disclosure of Health Care Items or Services to Health Plans When Patients Self Pay Out-of-Pocket (UH2923)
(VMC, see here)
FORM 104.F12 Additional Privacy Protections, Restrictions and Alternative Communications Coordination and Action Form
FORM 104.F13 Amendment Request (UH2078)
(VMC, see here)
FORM 104.F14 Accounting For Disclosure (UH3162)
(VMC, contact VMC HIM.)
104 Guidance
GUIDANCE 104.G1 Release of Information Charge Matrix
104 Templates
TEMPLATE 104.T1 Sample Letter: Access – Incomplete Request
TEMPLATE 104.T2 Sample Letter: Reviewable Grounds for Denial (partial)
TEMPLATE 104.T3 Sample Letter: Reviewable Grounds for Denial (whole)
TEMPLATE 104.T4 Sample Letter:Unreviewable Grounds for Denial
105 Breach Notification
POLICY COMP.105 Breach Notification
106 Use and Disclosure of Protected Health Information by Business Associates
POLICY COMP.106 Use and Disclosure of Protected Health Information by Business Associates
106 Template
TEMPLATE 106.T1 UW Medicine Business Associate Agreement
107 Information Security
POLICY COMP.107 Information Security