№ lp_1_2_47577
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This document includes various forms related to HIPAA privacy regulations, commonly used for handling patient health information disclosures and amendments.
Year:
2023
Region / City:
USA
Theme:
Health Information Privacy
Document Type:
Forms
Organization / Institution:
American Medical Association
Author:
American Medical Association
Target Audience:
Healthcare providers, medical practitioners
Effective Period:
N/A
Approval Date:
N/A
Amendment Date:
N/A
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
N/A
Region / City:
N/A
Theme:
Research, Health Information, HIPAA Authorization
Document Type:
Template
Organization / Institution:
UW Medicine, Fred Hutchinson Cancer Center
Author:
N/A
Target Audience:
Research Participants, Legal Representatives
Effective Period:
N/A
Approval Date:
N/A
Revision Date:
N/A
Note:
Year
Topic:
Research
Document Type:
Consent Form
Note:
Version Date
Year:
2013
Region / City:
United States
Topic:
Health Information Privacy
Document Type:
Regulatory Guidelines
Organization / Institution:
Department of Health & Human Services
Author:
Department of Health & Human Services
Target Audience:
Covered entities, business associates, legal professionals
Period of Validity:
Ongoing
Approval Date:
January 25, 2013
Amendment Date:
Not specified
Note:
Year
Topic:
Business Associate Agreement, HIPAA Compliance
Document Type:
Agreement
Year:
2026
Region / City:
United States
Subject:
Health information privacy
Document type:
Privacy notice
Organization:
Physician practice
Author:
Privacy Officer
Effective date:
[insert effective date]
Legal reference:
45 C.F.R. § 164.520
Target audience:
Patients
Rights covered:
Access, amendment, accounting of disclosures, confidential communications, special privacy protections
Year:
2023
Region / City:
United States
Topic:
Health Information Privacy
Document Type:
Agreement Template
Organ / Institution:
The HIPAA Journal
Author:
The HIPAA Journal
Target Audience:
Businesses handling Protected Health Information
Effective Date:
[Effective Date]
Date of Changes:
[Date of Changes]
Year:
2023
Region / City:
Philadelphia
Topic:
Research Consent Form
Document Type:
Informed Consent
Institution:
University of Pennsylvania
Author:
University of Pennsylvania Research Team
Target Audience:
Potential research participants
Study Duration:
Variable
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2024
Region / City:
United States
Topic:
Health Care, HIPAA Compliance, Electronic Transactions
Document Type:
Companion Guide
Organization:
UCare
Author:
UCare
Target Audience:
Health care providers, trading partners, billing services, software vendors, financial institutions
Period of Action:
2024
Approval Date:
11/01/2024
Date of Modifications:
Not specified
Year:
2016
Region / City:
Portland, OR
Topic:
Privacy / Data Protection
Document Type:
Letter
Organization:
OHCA
Author:
Not specified
Target Audience:
Individuals whose personal data may have been breached
Effective Period:
Not specified
Approval Date:
July 26, 2016
Modification Date:
Not specified
Note:
Year
Theme:
Healthcare, Legal, Medical Records
Document Type:
Authorization Form
Organization / Institution:
American Academy of Dermatology, JAAD International
Target Audience:
Patients, Legal Representatives
Year:
2025
Region / City:
Salt Lake City, Utah
Subject:
Jazz Dance
Document Type:
Course Syllabus
Institution:
University of Utah
Instructor:
Ruger Memmott
Target Audience:
Students enrolled in DANC 1210 and BALLE 2380
Period of Action:
Fall Semester 2025
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2021
Region / City:
National
Field:
Medical
Document Type:
Assessment Forms
Organization:
National Accreditation Board for Testing and Calibration Laboratories (NABL)
Author:
NA
Target Audience:
Laboratories, Assessor Teams, Medical Imaging
Period of Validity:
Not specified
Date of Approval:
16-Feb-2021
Amendment Date:
13-Jul-2023
The document outlines assessment forms and checklists used by the NABL for the accreditation of laboratories in accordance with ISO 15189:
2012 standards, including various schedules and witness reports for medical testing.
Year:
2025
Agency:
United States Social Security Administration
Form Numbers:
SSA-7161-OCR-SM, SSA-7162-OCR-SM
Type:
Report / Information Collection
Legal Basis:
Social Security Act Sections 203(c), 203(g), 205(a), 205(j), 1631(e)(1)(A); Strengthening Protections for Social Security Beneficiaries Act of 2018
Target Audience:
U.S. citizens and noncitizens receiving benefits abroad; representative payees
Collection Frequency:
Annual or biennial depending on circumstances
Purpose:
Verification of eligibility, reporting events affecting benefits, annual accounting for representative payees
OMB Control Number:
0960-0049
Psychological Considerations:
Potential respondent perception of intrusiveness
Delivery Method:
Mail, telephone verification
End of Reporting Period:
December 31 annually
Estimated Population:
Approximately 841,600 beneficiaries living abroad, 25,550 with representative payees
Annual Payments:
$677 million monthly ($8.1 billion annually)
Year:
2013
Region / City:
United States
Topic:
Lease Proposal Evaluation
Document Type:
Administrative Statement
Agency / Organization:
General Services Administration (GSA)
Author:
General Services Administration
Target Audience:
Federal Agencies, Lessors
Period of Validity:
Ongoing
Approval Date:
January 3, 2013
Amendment Date:
N/A
Note:
Year
Topic:
Navy Child and Youth Programs, Registration, Medical Requirements
Document Type:
Supporting Statement
Organization / Institution:
U.S. Navy
Target Audience:
Eligible patrons (active duty military, Coast Guard, DoD employees, retirees, contractors, etc.)