EmailMe Form - Data Privacy & HIPAA **Created 12/7/21

Date: *

MM / DD / YYYY

Site: *

Employee Name: *

First Last

1. Private data includes all information pertaining to a persons served, gathered by Zumbro House, and stored in the individual's file. *

False

True

2. Which of the following persons are NOT permitted access to a persons' served private data? *

The subject of the data privacy. (Person Served)

Person's legal representative.

Any individual who has a signed consent to view data.

Anyone who calls to ask about person served.

3.Staff are required to document in a persons served record, if any information is provided and to whom it is provided. *

True

False

4.Individuals requesting information must sign and submit which of the following forms? *

HIPAA Form

Release of Information Form

Assessments Form

Leave of Absence Form

5.During your shift, you receive a phone call from an unknown person, requesting information about a person served. What should you do? *

Ask who they are then give them the information requested.

Tell them you can't help and hang up.

Ask a peer if you should provide the requested information.

Request to take a message and give the message to your supervisor.

6.Any written or verbal exchange of information about a person served should be done in a way to preserve confidentiality. *

True

False

7.Neither Zumbro House staff, nor a legal representative, may permanently remove or destroy a persons served records. *

True

False

8. Sharing private data of a person served to unauthorized individuals is a HIPAA violation and will result in disciplinary action. *

True

False

9. When an incident involves more than one person served, the report must not disclose personally identifiable information about any other person served when making the report to teams, unless Zumbro House has signed consent. *

True

False

10. Once consent to disclose information is confirmed, Zumbro House may only release the minimum necessary amount of information required to respond. *

True

False

Employee Signature:

Clear

Multiple Choice

First option

Second option

Third option