This assignment will assess the competency X.P.2 Apply the HIPAA rules in regard a. privacy
Janel Darnish (dob 1/23/1968) is a patient coming into the clinic for an appointment and needs to sign her HIPAA acknowledgement form. She then informs you that she will be needing a copy of her medical records sent to another physician’s office, Wellness Healthcare, 1212 Brookway Drive, Anywhere, ND.
Using the work product attached below, complete the form as a patient
| Date of disclosure request | Disclosed to whom: address/e-mail | Description of disclosure | Purpose of disclosure | Dates of Service of disclosure | Person completing request | Date completed |
| Date of disclosure request | Disclosed to whom: address/e-mail | Description of disclosure | Purpose of disclosure | Dates of Service of disclosure | Person completing request | Date completed |
Date of disclosure request: [Insert Date]
Disclosed to whom: Wellness Healthcare
Address/e-mail: 1212 Brookway Drive, Anywhere, ND
Description of disclosure: Request for medical records
Purpose of disclosure: Continuity of care and sharing medical information with another healthcare provider
Dates of Service of disclosure: [Insert Date Range]
Person completing request: Janel Darnish
Date completed: [Insert Date]
In this scenario, Janel Darnish, born on 1/23/1968, is visiting the clinic for an appointment. As part of her visit, she needs to sign the HIPAA acknowledgement form. After signing the form, she informs the clinic staff that she requires her medical records to be sent to another physician’s office, Wellness Healthcare, located at 1212 Brookway Drive, Anywhere, ND.
To facilitate this request, the following information is completed on the disclosure request form:
Date of disclosure request: [Insert Date]
Disclosed to whom: Wellness Healthcare
Address/e-mail: 1212 Brookway Drive, Anywhere, ND
Description of disclosure: Request for medical records
Purpose of disclosure: The purpose of the disclosure is to ensure continuity of care and share Janel Darnish’s medical information with her new healthcare provider at Wellness Healthcare.
Dates of Service of disclosure: [Insert Date Range]
Person completing request: Janel Darnish
Date completed: [Insert Date]
This disclosure request form is essential to ensure that Janel Darnish’s medical records are accurately and securely transferred to her new healthcare provider as required by HIPAA regulations. It provides a record of the request, the purpose of the disclosure, and the details of the recipient to maintain patient privacy and confidentiality while allowing for the seamless transfer of necessary medical information.
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