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The Health Agency is actively responding to COVID-19 and continuing to provide other essential services. Please see updates from Animal Services, Behavioral Health, Public Guardian and Public Health

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Forms & Documents > Health Agency HIPAA Support Forms

Name Description Type
Confidentiality-Agreement _ Contractor-Visitor _ Non-PHI Confidentiality Agreement for Contractors who are not working with PHI - (Custodians, Painters, Plumbers, Etc.) File
Contractor-Confidentiality-Agreement _ With-Access-to-PHI Confidentiality Agreement for Contractors who are working with PHI (Auditors, Researchers, IT Specialists, Etc.) File
Email Encryption Instructions Email Encryption Instructions - For County Employees - (HIPAA Compliance) File
Health-Information-Privacy-and-Security-Complaint-Form Inquiry and complaint form for alleged privacy violations. File
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
Text-Messaging_E-Mail-Authorization-English-Spanish Text Messaging_E-Mail Authorization English-Spanish _ (HIPAA Compliance) This form is an agreement to allow clients and their provider to communicate via electronic means. File