Medical Privacy Project 2001

Medical Privacy Declaration Forms

 

Stored at HHS are nearly 52,000 public comments on the proposed medical privacy rule.
Stored at HHS are nearly 52,000 public comments on the proposed medical privacy rule.

1) Health and Medical Data Privacy Declaration Form (PDF File) View HTML file

RE: Health care services and medical record information, government databases.

Detailed Background Information and Contacts

2) Medical/Financial Privacy Declaration Form (PDF File) View HTML file

RE: Medical and financial information held by financial institutions and health and life insurers, and mergers of financial and insurance functions within these corporations.

Detailed Background Information and Contacts

3) Medical/Home Privacy Declaration Form (PDF File) View HTML file

RE: Federal data collection on homes and families through the provision of home health services; state and federal "citizen dossier" databases.

Detailed Background Information and Contacts


Note: Each declaration form has two (2) pages:

    Page 1: Explanation, Legal citations, Examples
    Page 2: Brief form to complete and to give to providers/companies/agencies
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Legal advice provided to CCHC by Linka K. Hopkins, Attorney at Law, Roseville, Minnesota, Intelliware International