AWPHD in cooperation with Physicians Insurance, Washington Casualty Company, the Washington State Hospital Association, and the Washington State Medical Association have produced Washington State specific forms in German, Russian, Spanish, Vietnamese and Tagalog to assist providers in their efforts to comply with the health care information privacy standards established by the Privacy Rules promulgated under the Health Insurance Portability & Accountability Act (HIPAA) of 1996. The English version of these forms are available electronically at www.phyins.com and at www.wacasualty.com.

Please note that these forms and materials are suitable specifically for Washington State. Please remember that the HIPAA Privacy Rule does not necessarily preempt (replace) state law; if a state law is more "stringent," the state law remains in force. Accordingly, if you have already implemented "national" forms, you are urged to reassess them as they may not be appropriate for Washington.

• English
• German
• Russian
• Spanish
• Tagalog
• Vietnamese

English:

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgment
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement

German: (download all documents)

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgement
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement

Russian: (download all documents)

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgement
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement

Spanish: (download all documents)

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgement
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement

Tagalog: (download all documents)

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgement
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement

Vietnamese: (download all documents)

• Authorization Form
• Revocation of Authorization Form
• NPP Form
• NPP acknowledgement
• Request to Access PHI Denial Letter
• Request to Amend PHI Form
• Request to Amend PHI Denial Letter
• Complaint Grievance Resolution Letter
• Employee confidentiality statement
• Non-Employee confidentiality statement