Record your answers on this form by selecting the correct letter:
1. What is protected health information (PHI)?
2. The National HIPAA privacy regulation:
3. The proper way to dispose of documents that contain client/patient information is by giving the documents to the parent/guardian for shredding.
4. If a client or fellow provider asks you about the client information you are handling, what do you do?
5. What are examples of protected health information?
6. Why is the HIPAA Privacy Rule important and how does it benefit our clients?
7. The HIPAA Privacy Rule talks about minimum necessary in regards to disclosing records. Minimum necessary is:
8. Ways we can best protect PHI is with:
9. Which of the following are examples of physical safeguards?
10. Which of the following are examples of technical safeguards?
11. When discussing client information in public areas at HHS you should:
12. When sending email that contains client information you should:
13. How can you control access to PHI?
14. For unauthorized or improper use/disclosure of PHI, which of the following can happen to you?
15. When a privacy violation occurs, you should do the following:
16. When you become aware of a potential privacy or security breach, how soon should you contact the client’s parent/guardian and service coordinator?
Broadscope Disability Services
I understand that information obtained about persons served by Broadscope Disability Services is to be kept confidential under the requirements established by Wisconsin State Law and the Wisconsin Administrative Code.
I also understand that all treatment records shall remain confidential and are privileged information to the subject individual. Such records may be released only as permitted by the Wisconsin Statutes (Chapter 51.30) and the Wisconsin Administrative Code (HFS 92.01(1)). A release of information requires the informed written consent of the subject individual except in the few special circumstances noted in these regulations. (Note that “Treatment Records” include spoken information about the person who is receiving services.)
I understand that the information about service recipients is privileged and confidential. I agree not to make unauthorized copies of confidential materials, allow any unauthorized person access to them or discuss them with anyone who is not specifically authorized.
My electronic signature below indicates I acknowledge that failure to adhere to the requirements set forth in this statement could constitute a violation of the Law, a violation of the public trust and discontinued reimbursement by Broadscope Disability Services.