Louisiana Request for Accounting of Disclosures of Protected Health Information

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Multi-State
Control #:
US-3581
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Word; 
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Description

This form is used by an individual to request an accounting of the persons or entities to whom the individual's protected health information has been disclosed. Permitted exclusions from the accounting are also described.
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How to fill out Request For Accounting Of Disclosures Of Protected Health Information?

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FAQ

Under the HIPAA Privacy Rule, a covered entity must act on an individual's request for access no later than 30 calendar days after receipt of the request.

When releases occur that are pursuant to Accounting of Disclosures, the log must include certain elements like: the date of the disclosure; the name and address of the organization / person who received the PHI; a brief description of the PHI disclosed; and.

A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.

Under the HIPAA Privacy Rule, an individual, under certain circumstances, has the right to receive an accounting of disclosures HIPAA Accounting of that individual's protected health information (PHI) made by a covered entity in the last six years prior to the date on which the account is requested.

For each disclosure, the accounting must include: (1) The date of the disclosure; (2) the name (and address, if known) of the entity or person who received the protected health information; (3) a brief description of the information disclosed; and (4) a brief statement of the purpose of the disclosure (or a copy of the

Patients (or their Personal Representatives see Yale Policy 5038 - Personal Representatives) may request an accounting of disclosures by submitting a request in writing using the Request for Accounting of Disclosures of Protected Health Information form, or other sufficient written documentation requesting the

The Privacy Rule at 45 CFR 164.528 requires covered entities to make available to an individual upon request an accounting of certain disclosures of the individual's protected health information made during the six years prior to the request.

Other instances necessitating Accounting of Disclosures (AOD) include: Those Required by Law (Court Orders, subpoenas, state reporting, emergencies) Public Health Activities (Prevention of disease, public health investigations) Victims of abuse, neglect, or domestic violence.

Under the HIPAA Privacy Rule, a covered entity must act on an individual's request for access no later than 30 calendar days after receipt of the request.

Other instances necessitating Accounting of Disclosures (AOD) include: Those Required by Law (Court Orders, subpoenas, state reporting, emergencies) Public Health Activities (Prevention of disease, public health investigations) Victims of abuse, neglect, or domestic violence.

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Louisiana Request for Accounting of Disclosures of Protected Health Information