Massachusetts 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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FAQ

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.

The Privacy Rule does not require accounting for disclosures: (a) for treatment, payment, or health care operations; (b) to the individual or the individual's personal representative; (c) for notification of or to persons involved in an individual's health care or payment for health care, for disaster relief, or for

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

With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.

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.

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.

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.

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.

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

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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Massachusetts Request for Accounting of Disclosures of Protected Health Information