Rather than charge purchasers of the book an additional $15 for a CD, I have made all of the forms from
the book available here for downloading at no cost (to you). If you have not bought the book, see the Warning below.
You can see what the forms look like in the book and decide which ones you want to modify. Each form is in .rtf (Rich Text Format). Click on the title of the form to open it, select all the text with your mouse or use Select All, copy it, and paste it into a page in your favorite word processor.
To make the forms match the appearance of those in the book, set the margins of your document to those of the forms here - top, bottom, left and right are all .25 of an inch and the document is set in the Palatino font.
Please
remember that HIPAA does NOT provide any kind of standard language or
wording to be used on forms and so ALL of the following forms and letters
are simply my best guess at what you need. Oh, and remember I am not a
lawyer.
1. These forms are copyrighted. DO NOT SHARE THEM, please. You have the right to use them with your clients in your own practice but not give or sell them to others and not to use them for teaching purposes. If your friend wants to use them, let him or her buy his or her own copy of HIPAAHelp.
2. Why do I insist on this? So I can get wealthy. Yeah, right. No, because I believe that using these in a mental health practice in our time, the Great Age of Litigation, without the background, understanding, and cautions learned from this book will expose the user to legal and ethical dangers he or she will not even be able to anticipate.
241 A preemption decision worksheet
261 Content and documentation of training
263 Confidentiality agreement for employees
312 Format for a routine progress note
313 Format for a psychotherapy note
411 The complete Notice of Privacy Practices
412 The briefer Notice of Privacy Practices
431 Consent to use and disclose your health information
451 The Standard Authorization Form
490 A Form for revoking an Authorization
611 Form to request limitations on disclosure of one’s PHI
621 Form to request alternative communication channels
631 Form to request access to one’s health information
641 Form to request correction/amendment off one’s PHI
651 Form for a medical record disclosure log
653 Form to request an accounting of disclosures
654 Form for an accounting of disclosures
661 Complaint form
800 Our HIPAA Policy and Procedures Manual
960 Email Confidentiality Notices
1050 What do you think? - Feedback form
Page revised Dec. 26, 2007