The following are policies, forms, and checklists that you may download to use and modify for your own practice. Click on a document below to download or view the file.

	HIPAA Readiness Checklist (revised 2/10/03)
	Sample Business Associate Agreement
	Sample (Chief) Privacy Officer Job Description
	Notice of Privacy Practices (NPP) Policy
	Non-Authorized Disclosures Policy (revised 2/10/03)
	Accounting of Non-Authorized Use or Disclosures Request Form (revised 2/10/03)
	Authorization Form Policy (revised 2/10/03)
	Authorization Form Sample (added 4/11/03)
	Medical Record Amendment Policy (revised 2/10/03)
	Medical Record Amendment Request Form (revised 2/10/03)
	Privacy Complaint Policy (revised 2/10/03)
	Privacy Complaint Form
	Minimum Necessary Disclosure Policy (revised 2/10/03)
	HIPAA Training Agenda (revised 2/10/03)
	Confidentiality Agreement
	Confidentiality Policy (revised 2/10/03)
	Patient Access to Medical Record Policy (revised 2/10/03)
	Patient Access to Medical Record Request Form (revised 2/10/03)
	Restriction of Use or Disclosure of PHI Form (revised 2/10/03)
	Restriction of Use or Disclosure of PHI Policy (revised 2/10/03)
	Notice of Privacy Policy (Courtesy of Baker & Hostetler LLP) (added 2/10/03)
	Authorization For Use And Disclosure Of Personal Health Information (Courtesy of Baker & Hostetler LLP) (added 2/10/03)
	Business Associate Addendum (Courtesy of Baker & Hostetler LLP) (added 2/10/03)
	Confidential Communications Request Form (added 2/10/03)
	Confidential Communications Policy (updated 3/12/03)
	Sample Privacy Officer Job Description (American Health Information Management Association) http://www.ahima.org/infocenter/models/PrivacyOfficer2001.cfm

Baker & Hostetler LLP documents used with permission.

Documents are in various file formats such as Microsoft Word and Adobe Acrobat Reader. Adobe® Acrobat® Reader® is free software that lets you view and print Adobe Portable Document Format (PDF) files. Click here to download it for free.