RESOURCE COLLECTION

DPH Privacy Policies

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

Documents

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

SHARING POLICIES

Authorization for Use and Disclosure of PHI C.1.0

Release of Protected Health Info. in a Major Emergency or Multi Casualty Incident Rev. 2_5_25
Published
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

C.13.1 Patients, Visitors, and Staff_Photo_Audio_Video Recording Updated 5_17_2023

Published
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

D1.0 Secure Delivery of PHI Policy Revised 2_5_2025
Published
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

Research Misconduct: Definitions and Procedures E.4.0

DPH Health Information Data Use Agreement Form E.5.1

AGREEMENTS

User Agreement for Confidentiality, Data Security, & Electronic Signature (F.1.0) Revised 2_5_25
Published
User Agreement for Confidentiality, Data Security and Electronic Signature (F.2.0) Rev. 2_5_25
Published

RETENTION & STORAGE OF PHI

Retention & Destruction of PHI G.1.0

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

Authorized Use of Third-Party Dialers I.2.0

Partner agencies

DPH Office of Compliance and Privacy Affairs
Department of Public Health