Procedures and Forms - General

Authorization to Use or Disclose or Release Form (pdf)     (doc)

Record of Inadvertent Disclosure (pdf)     (doc)

Record of Disclosure (pdf)    (doc)

Confidentiality Agreement (doc)
Confidentiality Agreement - Clinical Programs (doc)

Confidential Destruction Certificate (pdf)  (doc)

Distribution of the Notice of Privacy Practices - Procedure (pdf)
Distribution of the Notice of Privacy Practices - Letter (doc)

Request of Amendment of PHI - Procedure (pdf)
Request of Amendment of PHI from an Individual - Form (pdf)     (doc)
Request of Amendment of PHI from an Entity - Form (pdf)     (doc)

Request of Confidential Communications (pdf)     (doc)

Request of Privacy Protection of Protected Health Information - Policy and Procedure (pdf)
Request of Privacy Protection of Protected Health Information - Form (pdf)     (doc)

Documentation of Disclosures of Protected Health Information (pdf)

Designation of Individuals Who are Involved in My Payment or Treatment Decisions (pdf)

Breach Notification Policy (pdf)
Breach Notification Procedures (pdf)