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Health Insurance Portability & Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) is a Federal regulation governing the privacy of protected health information found in medical records and other related documentation. Only specific County programs are covered under this regulation.  The County also complies with the American Recovery and Reinvestment Act of 2009, Health Information Technology for Economic and Clinical Health Act, (HITECH Act), which requires notification to individuals if their unsecured PHI is improperly used or disclosed.

Privacy Forms
  • Approval of Request to Amend pdf |  Word
  • Disclosure Log pdf |  Word
  • Notification of Record Amendment Denial pdf |  Word
  • Notification to Amend Records pdf |  Word
  • Plan Authorization Form pdf |  Word
  • Privacy Official Designation pdf |  Word
  • Request to Amend pdf |  Word
  • Standard Authorization Forms pdf |  Word
Security Forms
  • Security Checklist with Definitions pdf |  Word
  • Breach Notification Flowchart for Agencies
  • Breach Notification Log pdf |  Word
  • Breach Notification Letter to Client template) pdf |  Word
  • HIPAA-HITECH Risk Assessment Form pdf |  Word
  • Breach Notice to HHS Secretary (outline to be used prior to submitting online at pdf |  Word
  • Media notice/press release of Data Breach (template) pdf |  Word
  • Courier/Internal Mail label (for use in transferring records/information) pdf |  Word
County HIPAA Compliance Officer

County HIPAA Compliance Officer

Salt Lake County Records Management and Archives
4505 South 5600 West
West Valley City, Utah 84120
Phone: 385-468-0813  
Fax: 385-468-0819