Please feel free to download the following forms to help you protect your health privacy.
- Consent Form: to give all providers, including health professionals, hospitals, labs, and pharmacies. Ask them not to disclose your health data without your consent. You have a right to request restrictions on data disclosures; however, providers CAN refuse and disclose your records for treatment, payment, and healthcare operations use.
- State and federal laws give greater protections to ‘sensitive’ health information. Use this form to request that sensitive data including psychotherapy notes, mental health records, genetic information, and information about sexually-transmitted diseases not be disclosed without your consent.
- Opt out of the AMA Database: to give all all Physicians . They may not know the AMA sells their ‘Masterfile Record’’ to marketers.
- Request Your Records
Section 164.524 of HIPAA: Access of Individuals to Protected Health Information
- Complaint Form to HHS
- Private Pay Form: if you pay for treatment or prescriptions yourself, you have a right to prevent that information from being disclosed to your health plan. Use this form to make sure that providers, health professionals, hospitals, pharmacies, and labs don’t disclose that data to your health plan.
- Health Record Banking Alliance – Explanation of HRBs including a Narrated Description
- Health Privacy Project – Summaries of State Laws
- National Conference of State Legislatures – State Security Breach Notification Laws
- Citizens Against Medical Information Offshoring
- Attrition.org, datalossdb.org – Data concerning the loss or theft of personal information, some of which affect medical or health privacy
- PHIPrivacy.net – News on Breaches of PHI and commentary
- PogoWasRight.org – Privacy news, data breaches, and privacy related events and resources from around the world.
- EPIC – Electronic Privacy Information Center – Medical Privacy
- Privacy ’08 – The eight main privacy issues from the 2008 election, Patient Privacy among them
- Healthcare Scene Blog Network – John Lynn’s extensive Newsletter covering EMR, EHR, HIE, and Healthcare IT
- Zones of Privacy: Who can see and use your medical records?
- The Elimination of Consent: How HIPAA evolved between its introduction in 1996 and the “Privacy Rule”
- Evidence of Disclosure: The Sharing, Selling, Re-selling and Unauthorized Use of Our Personal Health Information
- Data on Demand: Two companies dominate the field of selling prescription information to insurance companies: Medpoint & Intelliscript
- True Stories: A PDF of health privacy violations from the Health Privacy Project
- Data For Sale: How does health data leave the health care system? We are just beginning to learn where it goes.
- Myths, Facts and Law About Health IT and the Right to Health Information Privacy: Jim Pyles, American Psychoanalytic Association
- Definitions of Privacy – From privileged: privacy in law, ethics and genetic data
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