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i. Attach A appd01 Designated Record Set

ii. Attach A appd02 Limited Data Set from 45 CFR Part 164.514(e) HIPAA

iii. Attach A appd03 KCBHO Authorization for Use & Disclosure of PHI

iv. Attach A appd03A Multi-party Authorization for Disclosure & Use of PHI

v. Attach A appd03B KCBHO SUD Releases Description

vi. Attach A appd03C KCBHO Authorization for Use & Disclosure SUD PHI

vii. Attach A appd03D KCBHO Consent for SUD Client Lookup

viii. Attach A appd03E KCBHO Authorization to Disclose & Redisclose SUD PHI

ix. Attach A appd04 Maximum Potential Access to and Use of PHI by KCBHO Staff

x. Attach A appd05 Routine Disclosure of PHI by BHRD Staff

xi. Attach A appd06 Redisclosure of Enrollment Information without Client Consent

xii. Attach A appd06A KCBHO Provider Network MCOs

xiii. Attach A appd07 Request for Client Information without Authorization

xiv. Attach A appd08 Form for Invalid Authorizations

xv. Attach A appd09 Request to Communicate by Alternate Means

xvi. Attach A appd10 Log of Disclosures without Client Consent or Authorization

xvii. Attach A appd11 Request to Revoke Consents for the Release of Information

xviii. Attach A appd12 Request to Amend or Correct PHI

xix. Attach A appd13 Request to Restrict Access of PHI

xx. Attach A appd14 Request for an Accounting of Disclosures

xxi. Attach A appd15 Oath of Confidentiality

xxii. Attach A appd16 Disclosure of Minimum Necessary Electronic PHI

xxiii. Attach A appd17A Application for Access to Client Information Systems

xxiv.  Attach A appd17B Application for Access to Client Information Systems_BHO

xxv. Attach A appd18 Procedure for Making a CD Containing PHI

xxvi. Attach A appd19 DSHS Intranet Oath of Confidentiality for PHI

xxvii. Attach A appd20 KC Business Associate Agreement

xxviii. Attach A appd21 R&E Data Sharing Agreement

xxix. Attach A appd21A Data Security Requirements

xxx. Attach A appd21B Certification of Data Disposition

xxxi. Attach A appd21C Oath of Confidentiality-R&E Data Sharing Agreement

xxxii. Attach A appd22 Data Use Agreement for Limited Data Set

xxxiii. Attach A appd23 DSHS PRISM System Access Request Form

xxxiv. Attach B  Evaluation and Research Committee

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