Privacy and Security of Client Information
If you have any questions or difficulty in accessing this information, or you would prefer to receive it in an alternative language, please call us at 800-790-8049.
According to the Health Insurance Portability and Accountability Act (HIPAA), your provider or health insurer must give you a notice that tells you how they may use and share your health information and how you can exercise your rights. In most cases, you will get this notice on your first visit to your provider.
If you need this information in another language, please call 800-790-8049.
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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