Privacy Policies & Procedures Template Suite

One of the key requirements as stipulated in the HIPAA Privacy Rule 45 CFR Part 160 is, a covered entity has to develop and implement relevant policies and procedures necessary in business practices and employees to ensure amount of protected health information is kept at bare minimum. The HIPAA Privacy Policy and Procedures template suite contains 57 procedures, forms and policies and can be used by any healthcare organization or covered entity. These policies are developed and issued in MS word format making it easier to tailor them according to your organization's compliance requirements. The templates are presented in a standard format projecting sensitive organizational functions that need HIPAA remediation consideration.

These HIPAA policies cover all the major areas like:

  1. General policies regarding use and disclosure of PHI
  2. Minimum necessary rule for use and disclosure of PHI
  3. Patient rights regarding their own PHI
  4. Uses and disclosures not requiring patient authorization
  5. Special cases for restriction of uses and disclosures of PHI
  6. Organizational issues and safeguards

The templates suite includes following HIPAA Privacy policies and procedures.

  • Accept Access Request
  • Accounting for Disclosures
  • Acknowledgement of Receipt
  • Amendment to Record Form
  • Authorization for Release of Protected Health Information
  • Authorization To Use Disclose Protected Health Information
  • Business Associate Agreement
  • Business Associate Contracts and Other Arrangements
  • Complaint Process
  • Data Use Agreement Template
  • De-identified Information and Limited Data Sets
  • Denial Access Request
  • Denial Request to Amend Form
  • Disclosure Accounting Log for Medical Information
  • Disclosure of PHI with and without authorization Template
  • Disclosures Record Form
  • Document Retention Requirements
  • EHR accounting of disclosures
  • Employee Confidentiality Agreement
  • Execution of Business Associate Agreements with Contracts
  • Health Plan Notice of Privacy Practices
  • HIPAA Accept Amend Request Form
  • Identifying PHI and Designated Record Sets
  • Minimum Necessary
  • Multi-Organization Arrangements
  • Notice of Privacy Practices
  • Patient Right to Access PHI
  • PHI Release by Whistleblowers
  • Privacy Officer
  • Receipt of Payment when Disclosing PHI
  • Release for Abuse Neglect or Domestic Violence
  • Release for Confidential Communications
  • Release for Fundraising Purposes
  • Release for Health Oversight
  • Release for Judicial or Administrative Proceedings
  • Release for Law Enforcement
  • Release for Marketing Purposes
  • Release for Public Health
  • Release for Research Purposes
  • Release for Specific Government Functions
  • Release for Workers Compensation
  • Release of Information for Deceased Patients or Plan Members
  • Release of Information for Legal Representatives
  • Release of Information to a Minor
  • Release of Information to a Minor's Parents
  • Release of Information to Friends and Family Members
  • Release of Psychotherapy Notes
  • Release to Patient or Plan Member
  • Release to Avert Serious Threat to Safety
  • Request Confidential Communications Template
  • Request Restriction
  • Request to Amend Patient or Plan Member Record
  • Requests for Restriction policy
  • Required PHI Disclosures
  • Right to Object to Release for Certain Purposes
  • Safeguarding PHI
  • Training Requirements
  • Workforce Sanctions

Total cost: $300 Buy Now (Opens in New Window)

All the templates come in Microsoft Word/excel files so you can add, change and delete content as required to complete your HIPAA Privacy policies. If you have any questions, or if you wish to see samples from suite, please feel free to contact us at or call on (515) 865-4591.

Supremus Group LLC
855 SE Bell Ct, Suite 300
Waukee, IA 50263
Tel : (515) 865-4591 | Fax: (515) 221-2363
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