RESOURCE COLLECTION

DPH Privacy Policies

On this page, you will find current DPH wide privacy policies.

Documents

COVID-19 PRIVACY INFORMATION

Privacy Guidelines Regarding Employees' COVID-19 Status

GENERAL

DPH Privacy Policy A.1.0

HIPAA Compliance – Admin Policies A.2.0

HIPAA Compliance – Patient/Client Resident Rights regarding Protected Health Information (PHI) A.3.0

BREACHES

POSTER: Compliance and Privacy Hotline Poster B.1.0

Reporting of Unlawful or Unauthorized Access of PHI (Potential Breach) B.1.1

Major Privacy Breach Emergency Quick Reference Response Guide B.2.0

SHARING POLICIES

Authorization for Use and Disclosure of PHI C.1.0

Release of Protected Health Information in a Major Emergency or Multi-Casualty Incident C.2.0

DPH Privacy Policy Matrix - Sharing Protected Health Information for Treatment C.3.0

Use of Protected Health Information in Disciplinary Investigations and Proceedings C.4.0

Reporting Individuals with Lapse of Consciousness to DMV C.8.0

HIPAA Compliance: Social Media Policy C.12.0

Patients, Visitors and Staff Photo/Audio/Video Recording (Clinical and Operations Purposes) C.13.1

2024-05-13
FORM: Consent to Record/Authorization for Publication C.14.1

FORM: Data Sharing Request Form C.18.4

STORING AND DELIVERING PHI

Secure Delivery of PHI Policy D.1.0

FORM: Secure Delivery of PHI - Cover sheet for fax or mailing D.1.1

Sending Electronic Messages to Adult Patients D.1.2

RESEARCH/EVALUATION

Privacy and the Conduct of Research E.1.0

FORM: DPH Research Proposal Approval E.3.0

Research Misconduct: Definitions and Procedures E.4.0

DPH Health Information Data Use Agreement Form E.5.1

AGREEMENTS

User Confidentiality, Security and Electronic Signature Policy F.1.0

FORM: SFDPH User Agreement for Confidentiality, Data Security and Electronic Signature F.2.0

RETENTION & STORAGE OF PHI

Retention & Destruction of PHI G.1.0

FORMS - UNIVERSAL SUD AUTHORIZATION FORM

English K.1.0

Spanish K.2.0

Chinese K.3.0

Russian K.4.0

Tagalog K.5.0

FORMS - AUTHORIZATION FOR USE OR DISCLOSURE PHI

English G.4.0

Spanish G.5.0

Chinese G.6.0

SUMMARY NOTICE OF HIPAA PRIVACY PRACTICES POSTER KIT

English H.1.1

Spanish H.1.2

Chinese H.1.3

Russian H.1.4

Tagalog H.1.5

Vietnamese H.1.6

SUMMARY NOTICE OF HIPAA PRIVACY PRACTICES AND ACKNOWLEDGEMENT OF RECEIPT FORMS

English H.2.1

Spanish H.2.2

Chinese H.2.3

Russian H.2.4

Tagalog H.2.5

Vietnamese H.2.6

FULL NOTICE OF HIPAA PRIVACY RIGHTS

English H.3.1

Spanish H.3.2

Chinese H.3.3

Russian H.3.4

Tagalog H.3.5

Vietnamese H.3.6

ALL STAFF MEMOS REGARDING PRIVACY

New DPH Hotline Posters – please place in prominent area at your site I.1.0

Authorized Use of Third-Party Dialers I.2.0

Partner agencies

DPH Office of Compliance and Privacy Affairs