Forms & Documents > Health Agency HIPAA Support Forms

Name Description Type Action
Confidentiality-Agreement _ Contractor-Visitor _ Non-PHI Confidentiality Agreement for Contractors who are not working with PHI - (Custodians, Painters, Plumbers, Etc.) File Download
Contractor-Confidentiality-Agreement _ With-Access-to-PHI Confidentiality Agreement for Contractors who are working with PHI (Auditors, Researchers, IT Specialists, Etc.) File Download
Email Encryption Instructions Email Encryption Instructions - For County Employees - (HIPAA Compliance) File Download
Health-Information-Privacy-and-Security-Complaint-Form Inquiry and complaint form for alleged privacy violations. File Download
Request-to-Amend-Protected-Health-Information Request to amend health information. This form is intended to assist clients who feel there may be an error in their health record. File Download
Text-Messaging_E-Mail-Authorization-English-Spanish-Rev-9-17 Text Messaging_E-Mail Authorization English-Spanish- Rev. 9-17 _ (HIPAA Compliance) This form is an agreement to allow clients and their provider to communicate via electronic means. File Download