HIPAA Information--Documents

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A period of extremely frigid temperatures is forecast to impact Connecticut between the afternoon of Saturday, December 21, through Tuesday, December 24. Governor Lamont is activating the state's severe cold weather protocol during this period. To locate a shelter or warming center in Connecticut, call 2-1-1 or visit 211ct.org.

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