Federally Mandated Reporting/Disclosure Form

Program Title and Description:

Requires that all health care facilities or organizations that receive protected health care information, to protect that information from disclosure in accordance with HIPAA.

Who is Responsible for Reporting?

Primary Contact
University Privacy Officer, Burnie Snodgrass - Taylor Health and Wellness Center

Secondary Contact(s)
University Security Officer, Jim Taylor- Computer Services

Where is Information about HIPAA available?

In all University Health Care Components and at http://privacy.missouristate.edu/hipaa.

When should Notification about HIPAA be completed?

Before or at first visit by a patient or client to a University Health Care Component.

Why should notification be completed in Annual Security Report?

To provide part of a good faith effort to notify members of the University Community about HIPAA and the Notice of Privacy Practices.

How is HIPAA to be disclosed?

Information about HIPAA will be provided in the Annual Security Report, University Catalog, on the University’s website, and in all Health Care Components

Is notification required, and how?

A signed Acknowledgement of the Notice of Privacy Practices is only required if protected health information is obtain in written or oral form.   Notification about HIPAA is not required to be sent to all members of the University Community, but it would assist in showing a good faith effort which is required under HIPAA.