April 17, 2018

Sample HIPAA Privacy Documents and Forms

Sample Notice of Privacy Practices

HIPAA asks that you provide a Notice of Privacy Practices to your patients to explain to patients how you will use their Protected Health Information (PHI). This notice also reviews a patient’s privacy rights with respect to their personal health information. This document should be visible to patients in your office and provided in print or electronic format upon request. You can read more about HIPAA’s requirements for your Notice of Privacy Practices on the Department of Health and Human Services’ website. Download Meddkit’s recommended Notice of Privacy Practices, in compliance with HIPAA’s requirements here. Our version includes extra provisions to allow you additional flexibility for contacting patients electronically in order to promote your practice.

Sample General Authorization Form for Release of PHI

If your Notice of Privacy Practices does not cover your organization for electronic communication with patients for the purpose of promoting your practice, you will want new and existing patients to complete a General Authorization Form. This document will allow you to release PHI to a specific third-party, like Meddkit, for a specific purpose. Download the general authorization form to allow Meddkit to promote your practice to your patients here.   Note: These documents are templates only. They do not reflect the requirements of your state’s laws. You should consult with advisors (e.g., your state or local medical or specialty society, or legal or other counsel) familiar with your state’s privacy laws prior to using these documents. Meddkit does not provide legal advice and any documentation used in compliance with HIPAA, your state’s, municipality’s or federal laws should be reviewed with an attorney.