HIPAA Information for N.C. Division of Public Health Staff

Policy & Procedures

DPH Privacy and Security Manual

Table of Contents (PDF version for printing )

Part 1. Privacy

I. Division of Public Health Privacy Compliance
1. DPH Privacy Manual Introduction
2. DPH HIPAA Compliance Policy Statement
3. DPH Privacy Policy Scope
4. DPH Privacy Policy Scope Matrix (Excel file)
5. DPH Privacy Policy Applicability
6. DPH HIPAA Covered Health Care Components and Business Associate
II. Administrative
1. Administrative Requirements (Privacy Protections)
2. Privacy Official / Contact
3. Business Associates
4. Workforce
5. Privacy Safeguards
6. Privacy Complaints
7. Privacy Incident Report
8. Legal Occurrences
III. Use and Disclosure
1. Minimum Necessary
2. Research
3. Authorizations
4. Accounting of Disclosures
5. Use and Disclosure of PHI
6. De-Identification of PHI and Data Use Agreement
7. Marketing and Fundraising
IV. Client Rights
1. Notice of Privacy Practices
2. Personal Representatives
3. Designated Record Sets (DRS)
4. Client Privacy Rights
V. Forms
1. DPH Confidentiality Agreement
2. DPH Privacy Training Record
3. DPH Health Information Privacy Complaint
4. DPH Privacy Complaint Tracking Log
5. DPH Privacy Incident Report
6. NC DHHS Business Associate Addendum to Contract
7. NC DHHS Business Associate Addendum to MOU
8. NC DHHS Business Associate Memorandum of Understanding (stand alone)
9. NC DHHS Authorization to Disclose Health Information
10. NC DHHS Authorization to Disclose Health Information (Spanish) Complete
11. NC DHHS Authorization to Disclose Health Information for Research
12. DPH Patient Authorization to Permit Use and Disclosure of Health Information
13. Sample Acknowledgment Form: Receipt of Notice of Privacy Practices
14. DPH Permission to Use and Disclose Patient Health Information (Consent for TPO)
15. DPH Designated Record Set Template
16. DPH Request for Accessing/Inspecting/Copying Health Information
17. Request for Restrictions on Use and Disclosures of Health Information and Instructions
18. DPH Request for Amendment of Health Information
19. DPH Request for Alternative Means of Communication of Health Information
20. DPH Request for Accounting of Disclosures of Health Information
21. DPH Accounting of Disclosures of IIHI Made to a Single Source for Multiple Clients
22. DPH Accounting of Disclosures for Research Purposes
23. DPH Disclosures of IIHI (Non-Routine Disclosures) Log
24. DPH DUA (Data Use Agreement) template
25. DPH Permission to Tape Record/Photograph
26. DHHS Application for Waiver/Limited Waiver of Authorization for Research
27. Request for Access to Health Information for Research
28. DHHS Pledge of Confidentiality Form
VI. Privacy Manual Policy Supporting Material
1. NC DHHS HIPAA Documentation Retention Guidelines (draft)
2. NC DHHS HIPAA Guidance for Identifying Business Associates
3. NC DHHS External Business Associate Assessment Guidelines
4. NC DHHS Internal Business Associate Assessment Guidelines
5. DPH Business Associates of Internal Business Associate Summary
6. DPH External Business Associates Assessment Matrix
7. DPH Inventory of External Business Associates
8. Checklist for Client Authorizations
9. Questions and Answers: Consents & Authorizations
10. Memorandum on New State Law Regarding Disclosures of Patient Information for Purposes of Treatment, Payment, and Health Care Operations
11. Q&A on Revised NCGS 130A-12 Confidentiality (IOG)
12. DPH Designated Record Set Definition
13. NCHICA Guidance for Identifying Designated Record Sets
14. DPH State Lab Notice of Privacy Practices
15. DPH State Lab Notice of Privacy Practices (Spanish)
16. Instructions to request restrictions on Disclosures
17. Form 4056 instructions
18. DPH Contract Review Process for HIPAA Privacy Impacts
19. NC DHHS Work Area Privacy Physical Safeguards Assessment for HIPAA Privacy Compliance (Excel file)
20. NC DHHS Privacy Definitions

Current Effective Date: October 30, 2004

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Last Modified: September 12, 2018