Forms, Policies & Procedures

The Indian Health Service's (IHS) Learn, Train & Protect Health Insurance Portability and Accountability Act (HIPAA) training program includes a number of forms, policies and procedures that you must use and follow to comply with HIPAA standards. Each of the files below are in .pdf format and can be downloaded and read using Adobe Acrobat® Reader®. If you do not have Adobe Acrobat® Reader® on your computer, you may download it from the bottom of the left menu.

Notice of Privacy Practices

• IHS NOTICE OF PRIVACY PRACTICES (2007) COLORIZED PAMPHLET [PDF-561KB]

Forms

• Form IHS 810 - Authorization for Use and Disclosure of Health Information [PDF-305]
• Form IHS 912-1 Request for Restrictions [PDF-252]
• Form IHS 912-2 Request for Revocation of Restrictions (Fillable) [PDF-249]
• Form IHS 913 - Request for an Accounting of Disclosures [PDF-254]
• Form IHS 917 - Request for Correction/Amendment of Protected Health Information [PDF-277]
• Form IHS 963 - Request for Confidential Communication by Alternate Means or to an Alternate Location [PDF-60]

Policies and Procedures (P&P)

• PART 2 - SERVICES TO INDIANS AND OTHERS
  Chapter 7
  Health Insurance Portability and Accountability Act Privacy Rule and the Privacy Act