Get Hipaa Breach Log Sample

In this guide, you will learn how to accurately complete the Hipaa Breach Log Sample online. This vital tool assists health care providers in documenting potential health information privacy breaches and determining breach notification requirements under HIPAA.

Follow the steps to fill out the Hipaa Breach Log Sample online.

1. Press the ‘Get Form’ button to obtain the Hipaa Breach Log Sample and open it in your online editor.
2. Fill in the file number at the top of the form, followed by your name as the person completing the form.
3. Enter the date when the incident occurred and the date when it was detected.
4. Provide a brief summary of the incident, including how many patients were affected.
5. Indicate whether protected health information (PHI) was involved by selecting 'Yes' or 'No'. If PHI was involved, describe the information.
6. State whether the PHI was secured or unsecured. If unsecured, provide details regarding the nature of the PHI.
7. Indicate whether there was an acquisition, access, use, or disclosure of PHI not permitted by the Privacy Rule, and describe who accessed the PHI.
8. Check any applicable exceptions that might apply to the situation.
9. Conduct a risk assessment addressing every factor listed in the form, including the nature and extent of the PHI, the unauthorized recipient, and whether the PHI was actually viewed.
10. Based on your assessment, determine if there is a low probability that the PHI has been compromised. Indicate accordingly.
11. Sign and date the form, noting your title, before saving your progress.

Complete your documents online to ensure compliance and security.