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HIPAA Privacy Rule Confidentiality Form - Digital

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A digital, attorney-reviewed form to help covered entities document that employees who have access to protected health information (PHI) have been trained on privacy rule confidentiality requirements.

HIPAA Privacy Rule Confidentiality Form - Digital

All health care entities, health plans, and health care clearinghouses, as well as the business associates of such entities, must ensure compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rule. One requirement of the HIPAA privacy rule is that covered entities and business associates must train affected employees on company policy involving the confidentiality of protected health information (PHI).  Failure to comply with HIPAA privacy regulations can result in fines and penalties ranging from $100 per violation up to a maximum of $50,000.


Our attorney-reviewed HIPAA Privacy Rule Employee Confidentiality Form is designed to help covered businesses create a record of employee training concerning PHI use, disclosure, storage, and destruction as required under HIPAA.  The form also acts as documentation of the employee’s acknowledgment that they received the required training on their responsibilities regarding the HIPAA Privacy Rule.

Features & Benefits Include:

  • A digital form to help covered employers document that affected personnel have received required training regarding personal health information (PHI);
  • Attorney-reviewed to ensure compliance with HIPAA privacy rule requirements;
  • Printable, fill-in-the-blanks digital format for physical or electronic recordkeeping;
  • A detailed instruction sheet explaining how & when to use the form and how long to retain it.

Our attorney-reviewed form is designed to help employers:

  • Demonstrate compliance with the training, confidentiality, and recordkeeping requirements of the HIPAA privacy rule.
  • Document that employees who have access to PHI have been appropriately trained as required under HIPAA. 


  • If you are not completely satisfied, you can cancel your order within seven (7) days of receipt for a full refund.
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