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.

i. Privacy and Security of Client Information

ii. Protection of Confidential Client Information

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