HIPAA Notice of Privacy Practices Acknowledgment Form | Practical Law

HIPAA Notice of Privacy Practices Acknowledgment Form | Practical Law

A sample form to be provided by an individual to a covered entity (CE) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) acknowledging that the individual received the CE's Notice of Privacy Practices. This Standard Document, which does not address applicable state law privacy requirements, contains integrated notes with important explanations and drafting tips.

HIPAA Notice of Privacy Practices Acknowledgment Form

Practical Law Standard Document 2-502-5711 (Approx. 8 pages)

HIPAA Notice of Privacy Practices Acknowledgment Form

by Practical Law Employee Benefits & Executive Compensation
Maintained • USA (National/Federal)
A sample form to be provided by an individual to a covered entity (CE) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) acknowledging that the individual received the CE's Notice of Privacy Practices. This Standard Document, which does not address applicable state law privacy requirements, contains integrated notes with important explanations and drafting tips.