Any proposed changes to this form must first be approved by the Office of Culture, Ethics and Compliance. Please attach documents to the subjectвЂ™s informed consent document. This template has been reviewed and approved by the respective USC IRBs. See USC HIPAA Policy RES-301 for further information about using these forms. Instructions for completing HIPAA authorization form Must be provided to patient no later than first clinical encounter must be posted in conspicuous location at each clinical site*See USC Policy CLIN-200 for further information regarding use of the Notice of Privacy Practices. USC and DHS agreement to coordinate education effortsД®xplains the terms under which USC and Department of Health Services will accept the HIPAA education certification of the other institution. See USC Policy GEN-102 for further information regarding use of the authorization. This authorization form should be used and tailored for other uses and disclosures for which no other specific template document exists. Those specific authorization forms can be found below. USC has developed specific template authorizations for uses/disclosures of health information for (1) research (2), fundraising (3) marketing and (4) special privacy considerations. Questions about these policies should be directed to the USC Office of Culture, Ethics and Compliance at (213) 740-8258 or Also, see Cooperation with Compliance Investigations policy.Дated February 19, 2003, to university community regarding compliance with HIPAA privacy rule. The policies located on were developed to assist USC faculty and staff in complying with these regulations. If you have any questions about the confidentiality of your information, you may contact the Privacy Liaison at the Department office that provides your services, or our Director of Healthcare Privacy, at orВ 20.Federal regulations, known as the Health Insurance Portability and Accountability Act (HIPAA) privacy law, generally prohibit the use and disclosure of health information without written permission from the patient. If we find that an actual breach occurred, we will contact the individuals whose information is at risk and report the breach to government regulators and others as required by HIPAA or other applicable law. We will investigate any reported privacy or security incident that involves a Department office or program. Additionally, we may only work with other organizations that agree to safeguard your information as the law requires. We may use and share only the minimum information necessary to provide our services.

Those practices apply whether your information is verbal (such as when it is used in a conversation between staff who are working on your case,) written (such when it appears in a paper chart,) or electronic (such as when it is used in an electronic record system or email.) Minimum Necessary The Department conducts regular confidentiality training for its staff members and has policies and practices that we must follow to keep your information private and secure. We will no longer share your information after we receive your request. Revocation Form: If you change your mind and want to take back your permission to share your information, you may do so by completing the Revocation Form (PDF)В and sending it to the Department office where you receive services.

While the law allows the Department to use your information to serve you, the Department also has an authorization or release form available for you to use when you wish to share yourВ information with others. If you are receiving services from one of our HIPAA-covered entities, you can read about your rights in the Notice of Privacy Practices provided by that office. You have certain rights regarding your information. There can be steep penalties for failure to comply. Wherever you engage with the Department, know that there are federal or state laws, rules or regulations that we must follow to keep your information confidential.

Because the Department of Health and Human Services (the Department) has many different functions, HIPAA does not apply to all of our offices. HIPAA tells us how we may use your protected health information, and the types of safeguards that are required to keep your information secure. The Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules help protect your healthcare information. We take the protection of your information very seriously.В Our Director of Healthcare Privacy and Privacy Liaisons are here to help ensure that we follow the healthcare privacy requirements that apply to our work.

Medical office hipaa compliance forms