HIPAA Request for Accounting of Health Plan or Provider Disclosures | Practical Law

HIPAA Request for Accounting of Health Plan or Provider Disclosures | Practical Law

A sample form for use by an individual to request that a HIPAA covered entity (for example, a group health plan or certain health providers) provide the individual an accounting of disclosures of protected health information (PHI) made by the covered entity. This form is designed to comply with HIPAA, but does not address applicable state law requirements. This Standard Document has integrated notes with important explanations and drafting tips.

HIPAA Request for Accounting of Health Plan or Provider Disclosures

Practical Law Standard Document 6-502-5714 (Approx. 10 pages)

HIPAA Request for Accounting of Health Plan or Provider Disclosures

by Practical Law Employee Benefits & Executive Compensation
A sample form for use by an individual to request that a HIPAA covered entity (for example, a group health plan or certain health providers) provide the individual an accounting of disclosures of protected health information (PHI) made by the covered entity. This form is designed to comply with HIPAA, but does not address applicable state law requirements. This Standard Document has integrated notes with important explanations and drafting tips.