West Virginia Request for Accounting of Disclosures of Protected Health Information

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Multi-State
Control #:
US-3581
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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

Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

The HIPAA Privacy Rule gives a person the right to request a written record (an accounting) when a covered entity has made certain disclosures of that person's protected health information (PHI). The accounting must include all covered disclosures in the six years prior to the date of the person's 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.

The use and disclosure of PHI for purposes of TPO is allowed without a specific Authorization from the patient. Treatment means the provision, coordination and management of health care and related services by one or more health care providers.

More generally, HIPAA allows the release of information without the patient's authorization when, in the medical care providers' best judgment, it is in the patient's interest. Despite this language, medical care providers are very reluctant to release information unless it is clearly allowed by HIPAA.

HIPAA Disclosure Accounting or Accounting of Disclosures (AOD) is the action or process of keeping records of disclosures of PHI for purposes other than Treatment, Payment, or Healthcare Operations. You are required by law to provide patients a list of all the disclosures of their PHI that you have made outside of TPO.

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

We may disclose your PHI as authorized to comply with workers' compensation laws and other similar programs. Threats to Health or Safety. We may disclose limited PHI if we believe it is necessary to prevent or lessen a serious and imminent threat to you or to the public.

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

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West Virginia Request for Accounting of Disclosures of Protected Health Information