Revised HIPAA Privacy Form


As part of the ADA HIPAA Privacy Kit, a revised HIPAA Privacy Form 1, Notice of Privacy Practices, is available at at


The notice describes to patients how their health information may be used and disclosed and how patients can gain access to the information. Covered dentists are required to provide their patients an opportunity to read Notice of Privacy Practices and document that they've done so.


The words "locate and" are deleted in the revised form to convey U.S. Department of Health and Human Services counsel to the ADA that the HIPAA Privacy Act will not permit dentists to charge patients for time spent locating health care records.


The revised sample form replaces the previous form (use of which should be immediately discontinued) in the ADA HIPAA Privacy Kit. The ADA HIPAA Privacy Kit specifically addresses dental office issues by summarizing regulatory requirements under the Health Insurance Portability and Accountability Act of 1996.


For more information about HIPAA, visit . Dentists without Internet access can request a hard copy of the Notice of Privacy Practices form by calling the ADA Department of Dental Informatics, Ext. 4608.


Does HIPAA apply to you?


HIPAA regulations only apply to dental practices that submit or receive electronic transactions for which a standard has been established by the U.S. Department of Health and Human Services, either directly or through a vendor or clearinghouse.