This form is used by an individual to request an accounting of the persons or entities to whom the individual's protected health information has been disclosed. Permitted exclusions from the accounting are also described.
New Hampshire Request for Accounting of Disclosures of Protected Health Information is a formal legal document that individuals in New Hampshire can use to obtain information about the disclosure of their protected health information (PHI). This request is made under the Health Insurance Portability and Accountability Act (HIPAA), which grants individuals the right to know who has accessed or shared their personal health information. The New Hampshire Request for Accounting of Disclosures of Protected Health Information allows individuals to gain insight into the organizations, entities, or individuals that have accessed, used, or disclosed their PHI without their consent. It provides a means for individuals to keep track of how their health information is being handled and allows them to identify any potential violations of their privacy rights. By submitting this request, individuals can obtain a detailed account of the disclosures made by covered entities such as healthcare providers, health insurance companies, or any organization or individual that handles PHI. The accounting of disclosures will include information about the date, time, and nature of the disclosed information, as well as the identity of the recipient and the purpose for the disclosure. There are two primary types of New Hampshire Request for Accounting of Disclosures of Protected Health Information: 1. Standard Request: This is the most common form of request, typically used by individuals to obtain a comprehensive account of their PHI disclosures within a specific timeframe. This could include disclosures made for treatment purposes, billing and payment activities, healthcare operations, or any other purposes permitted under HIPAA. 2. Confidential Request: This type of request allows individuals to obtain an accounting of disclosures related to sensitive information, such as mental health records, substance abuse treatment, or HIV/AIDS-related information. It ensures that the individual's personal and sensitive information is handled with extra care and provides an additional layer of confidentiality and security. Submitting a New Hampshire Request for Accounting of Disclosures of Protected Health Information is an essential step in asserting one's rights over their personal health information. This document empowers individuals to keep track of who has access to their PHI and promote transparency and accountability in the healthcare system. It serves as a mechanism to safeguard privacy and reinforces patient control over their health information.
New Hampshire Request for Accounting of Disclosures of Protected Health Information is a formal legal document that individuals in New Hampshire can use to obtain information about the disclosure of their protected health information (PHI). This request is made under the Health Insurance Portability and Accountability Act (HIPAA), which grants individuals the right to know who has accessed or shared their personal health information. The New Hampshire Request for Accounting of Disclosures of Protected Health Information allows individuals to gain insight into the organizations, entities, or individuals that have accessed, used, or disclosed their PHI without their consent. It provides a means for individuals to keep track of how their health information is being handled and allows them to identify any potential violations of their privacy rights. By submitting this request, individuals can obtain a detailed account of the disclosures made by covered entities such as healthcare providers, health insurance companies, or any organization or individual that handles PHI. The accounting of disclosures will include information about the date, time, and nature of the disclosed information, as well as the identity of the recipient and the purpose for the disclosure. There are two primary types of New Hampshire Request for Accounting of Disclosures of Protected Health Information: 1. Standard Request: This is the most common form of request, typically used by individuals to obtain a comprehensive account of their PHI disclosures within a specific timeframe. This could include disclosures made for treatment purposes, billing and payment activities, healthcare operations, or any other purposes permitted under HIPAA. 2. Confidential Request: This type of request allows individuals to obtain an accounting of disclosures related to sensitive information, such as mental health records, substance abuse treatment, or HIV/AIDS-related information. It ensures that the individual's personal and sensitive information is handled with extra care and provides an additional layer of confidentiality and security. Submitting a New Hampshire Request for Accounting of Disclosures of Protected Health Information is an essential step in asserting one's rights over their personal health information. This document empowers individuals to keep track of who has access to their PHI and promote transparency and accountability in the healthcare system. It serves as a mechanism to safeguard privacy and reinforces patient control over their health information.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.