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 May 13, 2024 FORM: Consent to Record/Authorization for Publication C.14.1 FORM: Data Sharing Request Form C.18.4 Forms: Consent to Record/Chinese Version Forms: Consent to Record/Spanish Version Forms: Consent to Record/Tagalog Version 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 Departments DPH Office of Compliance and Privacy Affairs
