RESOURCE COLLECTION

DPH Privacy Policies

On this page, you will find current DPH wide privacy policies.

DPH Office of Compliance and Privacy Affairs

Documents

GENERAL

A.1.0 DPH Privacy Policy 2026.02.19
Published
A.2.0 HIPAA Administrative Requirements 2026.01.20
Published
A.3.0 Patient Rights Regarding Protected Health Information 2026.1.26
Published

BREACHES

B.1.0 Compliance and Privacy Hotline Poster 2025.01.01
Published
B.1.1 DPH Breach Reporting Policy 2026.02.19
Published

SHARING POLICIES

C.1.0 Authorization for Use and Disclosure of PHI 2026.02.11
Published
C.2.0 Release of Protected Health Information in a Major Emergency or Multi-Casualty Incident 2026.03.18
Published
C.3.0 DPH Privacy Matrix - Sharing Protected Health Information for Treatment 2022.06.01
Published
C.4.0 Use of Protected Health Information in Disciplinary Investigations and Proceedings 2026.02.19
Published
C.8.0 Reporting Individuals with Lapse of Consciousness to DMV 2026.02.20
Published
C.12.0 Social Media Policy 2026.03.16
Published
C.13.1 Personal and Care-Related Recording at DPH Facilities 2026.01.30
Published
FORM: Consent to Record/Authorization for Publication C.14.1

FORM: Data Sharing Request Form C.18.4

Form: Consent to Record Chinese Version
Published
Form: Consent to Record Spanish Version
Published
Form: Consent to Record Tagalog Version
Published

STORING AND DELIVERING PHI

D.1.0 Secure Delivery of Protected Health Information Policy 2026.03.11
Published
D.1.1 Secure Delivery of PHI Cover Sheet 2026.01.02
Published
D.1.2 Sending Electronic Messages to Adult Patients 2026.1.27
Published

RESEARCH/EVALUATION

E.1.0 Privacy and Conduct of Research 2021.12.14
Published
E.4.0 Research Misconduct: Definitions and Procedures 2022.12.28
Published
DPH Health Information Data Use Agreement Form E.5.1

AGREEMENTS

F.1.0 User Agreement for Confidentiality, Data Security, and Electronic Signature 2026.03.12
Published
FORM F.2.0 User Agreement for Confidentiality, Data Security, and Electronic Signature 2026.03.12
Published

RETENTION & STORAGE OF PHI

G.1.0 Retention Storage and Destruction of PHI 2026.02.05
Published

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

DPH NOTICE OF PRIVACY PRACTICES ENGLISH 2025.07.07
Published
DPH NOTICE OF PRIVACY PRACTICES SPANISH 2025.07.07
Published
DPH NOTICE OF PRIVACY PRACTICES CHINESE 2025.07.07
Published
DPH NOTICE OF PRIVACY PRACTICES RUSSIAN 2025.07.07
Published
DPH NOTICE OF PRIVACY PRACTICES TAGALOG 2025.07.07
Published
DPH NOTICE OF PRIVACY PRACTICES VIETNAMESE 2025.07.07
Published

ALL STAFF MEMOS REGARDING PRIVACY

Authorized Use of Third-Party Dialers I.2.0

Partner agencies

DPH Office of Compliance and Privacy Affairs
Department of Public Health