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This document outlines the responsibilities of covered entities under the HITECH Act and HIPAA Amendment regarding the notification process for breaches of unsecured protected health information (PHI).
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How to fill out patient notification of breach

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How to fill out Patient Notification of Breach of Unsecured PHI

01
Identify the breach incident and gather all relevant information about the unsecured PHI.
02
Determine the number of individuals affected by the breach.
03
Prepare a written notification that includes a description of the breach, the types of unsecured PHI involved, and any steps individuals can take to protect themselves.
04
Include contact information for individuals to ask questions or receive additional information.
05
Send the notification to affected individuals within 60 days of discovering the breach.
06
If applicable, notify the media and the Department of Health and Human Services (HHS) for larger breaches involving 500 or more individuals.

Who needs Patient Notification of Breach of Unsecured PHI?

01
Covered entities under HIPAA that have experienced a breach of unsecured PHI.
02
Business associates of covered entities who have breached unsecured PHI.
03
Any organization or individual handling PHI who is responsible for notifying affected persons.
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Individual Notice: Covered Entities must notify, in writing via first-class mail or email, any affected individuals following the discovery of a breach of Unsecured PHI. Notifications must be provided without unreasonable delay and in no case later than 60 days following the discovery of a Breach.
The written notice to individuals must include: A brief description of what happened, including the date of the breach and the date of the discovery of the breach. A description of the types of unsecure PHI involved. Any steps individuals should take to protect themselves from potential harm resulting from the breach.
The HIPAA breach notification requirements for letters include writing in plain language, explaining what has happened, what information has been exposed/stolen, providing a brief explanation of what the covered entity is doing/has done in response to the breach to mitigate harm, providing a summary of the actions that
The HHS Rule requires HIPAA-covered entities to notify people whose unsecured protected health information is breached. If you are a business associate of a HIPAA-covered entity and you experience a security breach, you must notify the HIPAA-covered entity you're working with.
Once a covered entity knows or by reasonable diligence should have known (referred to as the “date of discovery”) that a breach of PHI has occurred, the entity has an obligation to notify the relevant parties (individuals, HHS and/or the media) “without unreasonable delay” or up to 60 calendar days following the date
Following a breach of Unsecured PHI, Covered Entities must provide notification of the breach to affected individuals, the Secretary of Health and Human Services, and – in some circumstances – to the media. Business Associates must notify Covered Entities if a breach occurs at or by the Business Associate.
Breaches Affecting 500 or More Individuals If a breach of unsecured protected health information affects 500 or more individuals, a covered entity must notify the Secretary of the breach without unreasonable delay and in no case later than 60 calendar days from the discovery of the breach.

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Patient Notification of Breach of Unsecured PHI is a formal communication that informs patients when their unsecured protected health information (PHI) has been accessed or disclosed without authorization.
Covered entities including healthcare providers, health plans, and healthcare clearinghouses are required to file Patient Notification of Breach of Unsecured PHI.
To fill out the Patient Notification of Breach of Unsecured PHI, provide details such as the nature of the breach, the type of information involved, the corrective actions taken, and the contact information for further inquiries.
The purpose of Patient Notification of Breach of Unsecured PHI is to inform affected individuals about breaches of their sensitive health information, allowing them to take necessary precautions to protect themselves from potential harm.
The notification must include the date of the breach, type of PHI involved, description of the event, steps taken to mitigate harm, and contact information for questions.
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