The HIPAA Privacy and Security Rules 45 CFR 1643086i 45 CFR 1643086ii 45 CFR 164530d1 and 45 CFR 164530d2statea process to receive and document complaints regarding protected health informationPHIand ID: 884861
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1 HIPAA Incident and Concern Form The HIPA
HIPAA Incident and Concern Form The HIPAA Privacy and Security Rules (45 CFR 164.308(6)(i), 45 CFR 164.308(6)(ii), 45 CFR 164.530(d)(1) and 45 CFR 164.530(d)(2))statea process to receive and document complaints regarding protected health information(PHI)and to identify and respond to concerns regarding suspected or known security incidents must exist and be implemented. A concernis definedas a situation where more research or information is needed to determine if PHI is at risk. An example could include clarification of a HIPAA policy or procedure. An incidentis defined as a situation where HIPAA security and privacy policies or procedures have not been adhered to causing PHI to be at risk. Examples could include seeing an unauthorized, unescorted person in a secured area, someone sharing user names and passwords, or sending PHI unencrypted in an email or placing PHI on an unencrypted portable device. If you have a concern or believe you have witnessed an incidentregarding protected health information, complete elow653 or mail toATTN: HIPAA d, PO Box 4619, Rensselaer, NY 12144. Name Contact Phone Number : E - Mail address : or Provider Office Incident or Concern Date Location Where the ncident or Concern ccurred Who /Is Involved in the ncidentor Concern: Brief Description of the Incident or Concern: