Policies, Procedures, & Forms

1601 Information Access and Security

Policy 1601 Information Access and Security

Procedure 1601 PR.3 Access Control for Protected Health Information (PHI)

1609 Media Controls

Policy 1609 Media Control

Procedure 1609 PR.01 Disposal of Media Containing Confidential or Protected Health Information

1610 Systems and Network Security

Policy 1610 Systems and Network Security Policy

Procedure 1610 PR.01 Systems and Network Security

Procedure 1610 PR.02 Disposal of Obsolete Computers and Peripherals

Procedure 1610 PR.05 Device Security Standards

Guide 1610 GD.01 Selecting Good Passwords

5001 Notice of Privacy Practices

Policy 5001 Notice of Privacy Practices

Policy 5001A Notice of Privacy Practices - Group Health Plan

Procedure 5001 Notice of Privacy Practices

Procedure 5001 PR1 Notice of Privacy Practices - Group Health Plan

Form 5001 Notice of Privacy Practices - Group Health Plan

Form 5001 Notice of Privacy Practices - Yale Health

Form 5001 Notice of Privacy Practices - Yale Psychology Department Clinic

Form 5001 Notice of Privacy Practices - Yale School of Medicine - Spanish

Form 5001 Notice of Privacy Practices - Yale School of Medicine and Nursing

Form 5001 Notice of Privacy Practices - Yale School of Medicine - Display Notice

Form 5001 Notice of Privacy Practices - Yale School of Medicine - Display Notice - Spanish

NOPP Acknowledgement with Consent for Treatment - Yale School of Medicine

NOPP Acknowledgement with Consent for Treatment - Yale School of Medicine - Spanish

5002 Right to Request Access and Amendment to Designated Record Set

Policy 5002 Right to Request Access and Amendment to Designated Record Set

Procedure 5002B Right to Request Access and Amendment

Form 5002 Request Access to PHI in the Designated Record Set

Form 5002 Request Access to PHI in the Designated Record Set-Chinese

Form 5002 Request Access to PHI in the Designated Record Set-Japanese

Form 5002 Request Access to PHI in the Designated Record Set-Korean

Form 5002 Request Amendment of PHI Retained in Designated Record Set

Form 5002 Request Amendment of PHI Retained in Designated Record Set - Yale Health

Form 5002 Solicitación para acceso a PHI retenida en el expediente designado-Spanish

Form 5002 Solicitación para enmienda de la PHI retenida en el expediente designado

Fees for Record Requests

Designated Record Set

5003 Accounting for Disclosures

Policy 5003 Accounting for Disclosures

Procedure 5003 PR.1 Accounting for Disclosures

Form 5003 Accounting for Disclosure Log Spreadsheet

Form 5003 Accounting of Disclosures Log

Form 5003 Cuenta de Revelaciones

Form 5003 Request for Accounting of Disclosures of Protected Health Information

Form 5003 Response for Accounting of Disclosures

Form 5003 Solicitación para una Cuenta de Revelaciones de la Información de Salud Protegida (PHI)

5004 Request Restrictions or Confidential Communications

Policy 5004 Request Restrictions or Confidential Communications

Procedure 5004 PR.1 Request Restrictions or Confidential Communications

Form 5004 Request Confidential Communications - Yale Health

Form for Preferred Communication Methods

Form 5004 Request Confidential Communications - Spanish

Form 5004 Request Confidential Communications -Yale Medicine

Form 5004 Request Restrictions- Opt out of CareEverywhere

Form 5004 Requestion Restrictions- Opt out of CareEverywhere - Spanish

Form 5004 Request Restrictions on Uses and Disclosures of PHI Yale Medicine

Form 5004 Request Restrictions on Uses and Disclosures of PHI - Spanish

Form 5004 Request Restrictions on Uses and Disclosures of PHI - Yale Health

5005 Reporting Incidents Involving the Security or Privacy of Protected Health Information; Breach Notification

Policy 5005 Reporting Incidents Involving the Security or Privacy of Protected Health Information; Breach Notification

Procedure 5005 PR1 Reporting Incidents Involving the Security or Privacy of Protected Health Information;Breach Notification

5020 Disciplinary Policy for Violations of the Privacy or Security of Protected Health Information

5020 Disciplinary Policy for Violations of the Privacy or Security of Protected Health Information

5026 Reporting Protected Health Information (PHI) Compliance Issues

Policy 5026 Reporting Protected Health Information (PHI) Compliance Issues

5031 Authorization Requirements for Use and Disclosure of Protected Health Information, Including Verification of Identification

Policy 5031 Authorization Requirements for Use and Disclosure of Protected Health Information, Including Verification of Identification

Procedure 5031 Authorization Requirements for Use and Disclosure of Protected Health Information, Including Verification of Identification

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information – Yale Health

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information – YSM

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information-Chinese

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information-Japanese

Form 5031 Authorization Form for Use and Disclosure of Protected Health Information-Korean

Form 5031 Autorización para el Uso o la Revelación de Información-Spanish

5031 FR Case Study Authorization

Form 5031 Consent for Media Photographs and Interviews

Form 5031 Designation of Patient Spokesperson -Yale Medicine

Form 5031 Designation of Patient Spokesperson - Spanish

Form 5031 Designation of Patient Spokesperson - Yale Health

Form 5031 Release for Research

Exhibit 5031 Authorization Checklist

5032 Use and Disclosure of Protected Health Information for Research Purposes

Policy 5032 Use and Disclosure of Protected Health Information for Research Purposes

Procedure 5032 Determining Whether “Human Subject Research” Activity Involves Use/Disclosure of “Protected Health Information”

5031 FR Case Study Authorization

Form 5032 Compound Authorizations

Form 5032 Request for Access to Protected Health Information for Research Purpose

Form 5032 Request for Waiver of HIPAA Authorization for Research Use/Disclosure

Form 5032 Research Authorization (RAF)

Form 5032 Research Authorization (RAF) - Autorización para Hacer Investigación

Form 5032 Research Authorization Short Form - Albanian

Form 5032 Research Authorization Short Form - Amharic

Form 5032 Research Authorization Short Form - Arabic

Form 5032 Research Authorization Short Form - Bengali

Form 5032 Research Authorization Short Form - Bosnian

Form 5032 Research Authorization Short Form - Cantonese

Form 5032 Research Authorization Short Form - Chinese

Form 5032 Research Authorization Short Form - Czech

Form 5032 Research Authorization Short Form - English

Form 5032 Research Authorization Short Form - French

Form 5032 Research Authorization Short Form - Georgian

Form 5032 Research Authorization Short Form - Greek

Form 5032 Research Authorization Short Form - Gujarati

Form 5032 Research Authorization Short Form - Haitian Creole

Form 5032 Research Authorization Short Form - Hebrew

Form 5032 Research Authorization Short Form - Hindi

Form 5032 Research Authorization Short Form - Italian

Form 5032 Research Authorization Short Form - Korean

Form 5032 Research Authorization Short Form - Polish

Form 5032 Research Authorization Short Form - Portuguese

Form 5032 Research Authorization Short Form - Punjabi

Form 5032 Research Authorization Short Form - Russian

Form 5032 Research Authorization Short Form - Sinhalese

Form 5032 Research Authorization Short Form - Spanish

Form 5032 Research Authorization Short Form - Tagalog

Form 5032 Research Authorization Short Form - Tamil

Form 5032 Research Authorization Short Form - Thai

Form 5032 Research Authorization Short Form - Turkish

Form 5032 Research Authorization Short Form - Ukranian

Form 5032 Research Authorization Short Form - Urdu

Form 5032 Research Authorization Short Form - Vietnamese

Form 5032 Research Authorization Short Form - Yiddish

Release for Research

Providing Access to Protected Health Information for a Research Purpose

5033 Disclosure of PHI to Business Associates

Policy 5033 Disclosure of PHI to Business Associates

Procedure 5033 Disclosure of PHI to Business Associates

Form 5033 Disclosure of PHI to Business Associates Tracking Form

Flow Chart for Determining a Business Associate

5034 Uses and Disclosures of PHI for Marketing

Policy 5034 Uses and Disclosures of PHI for Marketing

Procedure 5034 Uses and Disclosures of PHI for Marketing

5035 Uses and Disclosures of PHI for Fundraising

Policy 5035 Uses and Disclosures of PHI for Fundraising

Procedure 5035 Uses and Disclosures of PHI for Fundraising

Fundraising FAQ Guidance

5036 Transmission and Receipt of Protected Health Information via Fax

Policy 5036 Transmission and Receipt of Protected Health Information via Fax

Procedure 5036 Transmission and Receipt of Protected Health Information via Fax

Fax Confidentiality Statement

Fax Cover Sheet – Yale School of Medicine

5037 Minimum Necessary Uses, Disclosures, and Requests

Policy 5037 Minimum Necessary Uses, Disclosures, and Requests

Procedure 5037 Minimum Necessary Uses, Disclosures, and Requests

Exhibit A - General Role Based Access Protocol and Criteria

Exhibit B – Routine or Recurring Disclosures Protocol and Criteria

Exhibit C – Minimum Necessary Criteria for Non Routine Disclosure/Request

5038 Personal Representatives

Policy 5038 Personal Representatives

Procedure 5038 Personal Representatives

5039 Use and Disclosure of De-Identified Information and of Limited Data Sets

Policy 5039 Use and Disclosure of De-Identified Information and of Limited Data Sets

Procedure 5039 Use and Disclosure of De-Identified Information and of Limited Data Sets

Form 5039 Data Use Agreement - For Yale Internal Research Uses

Exhibit A - De-Identified Data Information

Exhibit B – Limited Data Set Information

5040 Uses and Disclosures of Genetic Information for Underwriting Purposes

Policy 5040 Uses and Disclosures of Genetic Information for Underwriting Purposes

5100 Electronic Protected Health Information (ePHI) Security Compliance: HIPAA Security Anchor Policy

Policy 5100 Electronic Protected Health Information (ephi) Security Compliance: HIPAA Security Anchor Policy

Exhibit A - Criticality & Recovery Preparedness: ePHI Systems

5111 Physical Security Policy

Policy 5111 Physical Security

Procedure 5111 PR1 Physical Facility Security Plan for University and ITS Data Centers

Procedure 5111 PR2 Physical Access and Environmental Supports to Protected Health Information

5123 Electronic Communication of Health Related Information (Email, Voice Mail and other Electronic Messaging Systems)

Policy 5123 Electronic Communication of Health Related Information (Email, Voice Mail and other Electronic Messaging Systems)

Form 5123 Designation of Contact Information

5142 Information System Activity Review

Policy 5142 Information System Activity Review

Procedure 5142 PR1 Information System Activity Review (ISAR)

5143 IT Security Incident Response Policy

Policy 5143 IT Security Incident Response Policy