Patients who request an amendment to their health information must complete this form. To be used when a clinical unit denies a patient’s request to access health information (see PAT 601 Access to Protected Health Information). Patients who request access to their health information must complete this form. This document should be signed prior to using individual identifiable health information (e.g., treatment, diagnosis) for purposes of photographing or videotaping patients for education and instruction. This document should be signed prior to using individual identifiable health information (e.g., treatment, diagnosis) for purposes of videotaping or filming interviews with patients for public relations purposes.Īuthorization to Use Protected Health Information for Education and Instruction This document should be signed prior to using individual identifiable health information (e.g., treatment, diagnosis) for marketing activities.Īuthorization to Use Protected Health Information for Public Relations and Other Media Purposes This document should be signed prior to using individual identifiable health information (e.g., treatment, diagnosis) for fundraising activities.Īuthorization for USC Marketing Activities To be signed by all recipients of limited data sets.Īuthorization for USC Fundraising Activities Should be signed by investigators accessing USC or non-USC health information for purposes of conducting research on decedents May ONLY be used in connection with USC-held protected health information.ĬERTIFICATION Request for Decedent Protected Health Information
Should be signed by USC researchers accessing health information for purposes of subject recruitment or for other purposes preparatory to research. Please see instructions for use for further information.ĬERTIFICATION Request for Protected Health Information for Preparatory Research Activities Any proposed changes to this form must first be approved by the Office of Culture, Ethics and Compliance. Please attach documents to the subject’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 effortsĮxplains 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.ĭated 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. Focus on your patients instead of on HIPAA.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.Have peace of mind with HIPAA compliance.No client has ever failed an OCR/CMS audit.Once you've achieved compliance, you can showcase your status by displaying Compliancy Group's HIPAA Seal of Compliance on your practice's website. You and your staff will recieve support to achieve, illustrate and maintain compliance, including employee training, Security Risk Assessments, Business Associate Agreement templates and everything else you need for HIPAA compliance. Simplify compliance & move forward with confidence
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Compliancy Group offers AOA members free HIPAA education through monthly webinars and resources, covering a variety of topics to help you protect your practice. Its web-based compliance solution allows you and your practice to implement a total HIPAA compliance program with ongoing support from its team of expert compliance coaches. Compliancy Group is optometry's choice for HIPAA compliance.
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