Free HIPAA reference template · v1.0 · Applies to covered entities
Free, no signup needed. A ready-to-fill spreadsheet (.xlsx) with dropdowns and examples.
Adopting this document means committing to these HIPAA controls, the 45 CFR §164 requirements it helps satisfy, by area:
Template (spreadsheet). The log that lets you answer an individual's request for an accounting of disclosures of their PHI.
The running record of accountable PHI disclosures, so you can produce an accounting on request: the artifact behind an individual's right to know where their information went.
One row per accountable disclosure:
Record each accountable disclosure when it's made: those not for treatment, payment, or operations and not otherwise excepted. Disclosures to the individual and those under a valid authorization are generally excluded; when in doubt, log it. Individuals may request an accounting covering the prior six years. Satisfies the right to an accounting of disclosures at 45 CFR § 164.528.
See where your organization stands on the controls this template cites.
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