California Request for Accounting of Disclosures of Protected Health Information

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Multi-State
Control #:
US-3581
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Word; 
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Description

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.
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How to fill out Request For Accounting Of Disclosures Of Protected Health Information?

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FAQ

For each disclosure, the accounting must include: (1) The date of the disclosure; (2) the name (and address, if known) of the entity or person who received the protected health information; (3) a brief description of the information disclosed; and (4) a brief statement of the purpose of the disclosure (or a copy of the

An accounting of disclosures form may be necessary if you disclose patient records for the purposes of selling them, for scientific research if the data has not been de-identified, if they consented to having their info included in a client marketing story, or if their information has been disclosed for other marketing

HIPAA enables patients to learn to whom the covered entity has disclosed their PHI. This is called an accounting of disclosures. The accounting will cover up to six years prior to the individual's request date and will include disclosures to or by business associates of the covered entity.

For each disclosure, the accounting must include: (1) The date of the disclosure; (2) the name (and address, if known) of the entity or person who received the protected health information; (3) a brief description of the information disclosed; and (4) a brief statement of the purpose of the disclosure (or a copy of the

HIPAA gives an individual the right to request and receive a 6-year written accounting of non-routine PHI disclosures. An individual may receive an accounting of non-routine PHI disclosures for the period from January 1998 to January 2003.

Designated record sets include medical records, billing records, payment and claims records, health plan enrollment records, case management records, as well as other records used, in whole or in part, by or for a covered entity to make decisions about individuals. See 45 CFR 164.501.

Other instances necessitating Accounting of Disclosures (AOD) include: Those Required by Law (Court Orders, subpoenas, state reporting, emergencies) Public Health Activities (Prevention of disease, public health investigations) Victims of abuse, neglect, or domestic violence.

Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

HIPAA Disclosure Accounting or Accounting of Disclosures (AOD) is the action or process of keeping records of disclosures of PHI for purposes other than Treatment, Payment, or Healthcare Operations. You are required by law to provide patients a list of all the disclosures of their PHI that you have made outside of TPO.

Patients (or their Personal Representatives see Yale Policy 5038 - Personal Representatives) may request an accounting of disclosures by submitting a request in writing using the Request for Accounting of Disclosures of Protected Health Information form, or other sufficient written documentation requesting the

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California Request for Accounting of Disclosures of Protected Health Information