List of HIPAA Privacy Policies, Forms & Procedures in Templates Suite


Following are the 57 HIPAA Privacy forms, policies, and procedures included in the HIPAA Privacy Policy & procedures template suite. These templates are updated for the HITECH act of 2009 and Omnibus rule of 2013. The policies can be used by any covered entity & business associate. All policies are available in MS Word format and can be easily customized as per your requirements. Each template is presented in a standard format reflecting critical organizational functions to consider in HIPAA remediation.

HIPAA Privacy Policies cover areas like:

1) General policies regarding use and disclosure of PHI
2) Minimum necessary rule for use and disclosure of PHI
3) Patient rights regarding their own PHI
4) Uses and disclosures not requiring patient authorization
5) Special cases for restriction of uses and disclosures of PHI
6) Organizational issues and safeguards

The templates suite includes the following HIPAA Privacy Form, Policy, and procedures.

  • Accept Access Request
  • Accounting for Disclosures
  • Acknowledgment of Receipt
  • Amendment to Record Form
  • Authorization for Release of Protected Health Information
  • Authorization To Use Disclose Protected Health Information
  • Business Associate Agreement
  • Business Associate Contracts and Other Arrangements
  • Complaint Process
  • Data Use Agreement Template
  • De-identified Information and Limited Data Sets
  • Denial Access Request
  • Denial Request to Amend Form
  • Disclosure Accounting Log for Medical Information
  • Disclosure of PHI with and without authorization Template
  • Disclosures Record Form
  • Document Retention Requirements
  • EHR accounting of disclosures
  • Employee Confidentiality Agreement
  • Execution of Business Associate Agreements with Contracts
  • Health Plan Notice of Privacy Practices
  • HIPAA Accept Amend Request Form
  • Identifying PHI and Designated Record Sets
  • Minimum Necessary
  • Multi-Organization Arrangements
  • Notice of Privacy Practices
  • Patient Right to Access PHI
  • PHI Release by Whistleblowers
  • Privacy Officer
  • Receipt of Payment when Disclosing PHI
  • Release for Abuse Neglect or Domestic Violence
  • Release for Confidential Communications
  • Release for Fundraising Purposes
  • Release for Health Oversight
  • Release for Judicial or Administrative Proceedings
  • Release for Law Enforcement
  • Release for Marketing Purposes
  • Release for Public Health
  • Release for Research Purposes
  • Release for Specific Government Functions
  • Release for Workers Compensation
  • Release of Information for Deceased Patients or Plan Members
  • Release of Information for Legal Representatives
  • Release of Information to a Minor
  • Release of Information to a Minor’s Parents
  • Release of Information to Friends and Family Members
  • Release of Psychotherapy Notes
  • Release to Avert Serious Threat to Safety
  • Request Confidential Communications Template
  • Request Restriction
  • Request to Amend Patient or Plan Member Record
  • Requests for Restriction policy
  • Required PHI Disclosures
  • Right to Object to Release for Certain Purposes
  • Safeguarding PHI
  • Training Requirements
  • Workforce Sanctions


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The templates are available at our online HIPAA store for purchase. All the templates come in Microsoft Word/excel files so you can add, change and delete the content as required to complete your HIPAA Privacy policies.

If you have any questions, please feel free to contact us at or call on (515) 865-4591

HIPAA Privacy Policies, Forms & Procedures

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