#6 – Understands Health Information Privacy Policies & Procedures

These Health Information Privacy Policies & Procedures implement our obligations to protect the privacy of individually identifiable health information that we create, receive, or maintain as a healthcare provider.

We implement these Health Information Privacy Policies and Procedures as a matter of sound business practice; to protect the interests of our patients; and to fulfill our legal obligations under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), its implementing regulations at 45 CFR Parts 160 and 164 (65 Fed. Reg. 82462 (Dec. 28, 2000)) (“Privacy Rules”), as amended by modifications proposed by the U.S. Department of Health and Human Services (HHS) in March of 2002, and state law that provides greater protection or rights to patients than the Privacy Rules.

As a member of our workforce or as our Business Associate, you are obligated to follow these Health Information Privacy Policies & Procedures faithfully. Failure to do so can result in disciplinary action, including termination of your employment or affiliation with us.

These Policies & Procedures address the basics of HIPAA and the Privacy Rules that apply in our dental practice. They do not attempt to cover everything in the Privacy Rules. The Policies & Procedures sometimes refer to forms we use to help implement the policies and to the Privacy Rules themselves when added detail may be needed.

Please note that while the Privacy Rules speak in terms of “individual” rights and actions, these Policies & Procedures use the more familiar word “patient” instead; “patient” should be read broadly to include prospective patients, patients of record, former patients, their authorized representatives, and any other “individuals” contemplated in the Privacy Rules.

If you have questions or doubt about any use or disclosure of individually identifiable health information or about your other obligations under these Health Information Privacy Policies & Procedures, the Privacy Rules or other federal state law, consult ___________________ , before you act.

Read our HIPAA notice. This is located: ________________________. After reading it, answer the following questions:

What do we do if a patient refuses to sign to the HIPAA form?

What are 3 things you personally do to meet the HIPAA requirement.


I, __________________________________, have received and reviewed a copy of health information privacy policies and procedures for __________________________________ (Practice name).

Print Name



Please read information in master manual and be prepared to discuss this with ______________.

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