DSS: HIPAA and Your Privacy Rights

HIPAA and Your Privacy Rights

Client information at DSS is protected by federal and state laws and regulations. This section contains copies of these laws and regulations, the DSS Privacy Policy and official DSS forms related to your privacy rights.

Privacy Documents - The following documents are in PDF format 

 HIPAA and Your Privacy Rights (PDF 378KB)

Appendix A

 Notice of Privacy Practices (English) (PDF 27KB)
 Notice of Privacy Practices (Versión en Español) (PDF 122KB)

Appendix B - Forms

 Authorization of Disclosure of Information W-298 (PDF 84KB)
 Authorization of Disclosure of Information (Versión en Español) W-298s (PDF 87KB)
 Request for Access to Protected Health Information. (PDF 95KB)
 Request for Amend Protected Health Information. (PDF 30KB)
 Request to Restrict Use/Disclosure of Protected Health Information. (PDF 23KB)
 Breach Reporting of PII or PHI W-1701.pdf 
 Breach Risk Assessment W-1702.pdf
 Breach ResolutionW-1703.pdf  

Appendix C

Guidance Specifying the Technologies and Methodologies that Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals. (PDF 130KB)

Appendix D

 HIPAA Privacy, Security and Breach Notification Rules. (PDF 815KB)

Appendix E

 State Confidentiality Statutes (PDF 62KB)
 Responsibilities Disclosure UPM (PDF 764KB)

Appendix F

 SNAP ConfidentialityRegulations (PDF 57KB)
 Medicaid Confidentiality Regulations (PDF 90KB)    


Content Last Modified on 7/9/2015 8:06:31 AM