HIPAA Information--Documents

Warning!

It seems that JavaScript is not working in your browser. It could be because it is not supported, or that JavaScript is intentionally disabled. Some of the features on CT.gov will not function properly with out javascript enabled.

Settings Menu

Language
High Contrast
High Contrast Mode On or Off switch
Font Size
Disclaimer

Far below normal precipitation has caused a drought and increased fire danger levels. All of Connecticut is currently in a Stage 2 Drought Advisory. Residents are encouraged to be mindful of water consumption and use extra caution to prevent fires. An emergency burn ban remains in effect at all state parks, forests, and wildlife management areas, prohibiting the use of all outdoor grills, firepits, campfires, etc.

HIPAA Information

Documents/Forms

HIPAA and Your Privacy Rights

Appendix A
Notice of Privacy Practices (English)
Notice of Privacy Practices (Versión en Español)

Appendix B - Forms
Authorization of Disclosure of Information W-298
Authorization of Disclosure of Information (Versión en Español) W-298s

Request for Access to Protected Health Information.

Request for Amend Protected Health Information.

Request to Restrict Use/Disclosure of Protected Health Information.

Breach Reporting of PII or PHI W-1701.pdf

Breach Risk Assessment W-1702.pdf

Breach ResolutionW-1703.pdf

Appendix C
Guidance Specifying the Technologies and Methodologies that Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals.

Appendix D

HIPAA Privacy, Security and Breach Notification Rules.

Appendix E

State Confidentiality Statutes

Responsibilities Disclosure UPM

Appendix F

SNAP ConfidentialityRegulations

Medicaid Confidentiality Regulations