DHS Privacy Forms

Nine new forms have been developed as part of the HIPAA implementation process.

These forms give clients/patients a variety of ways to specify their privacy requests and cover other HIPAA requirements.

Down load HIPAA Privacy Glossary in or format.

Form Number		Form Name
DHS 2091		Privacy Program Statement of Understanding
DHS 2092		DHS Notice of Privacy Practices, Acknowledgment of Receipt
DHS 2093		Access to Records Request Form
DHS 2094		Amendment of Health Record Request Form
DHS 2095		Restriction of Use and Disclosures Request Form
DHS 2096		Accounting of Disclosures Request Form
DHS 2097		Disclosures of Protected Health Information
DHS 2098		Safeguard Assessment Tool
DHS 2099		Guidance for Admin Tech Physical Safeguard for PHI