hipaa notebook - amazon s3...2017/05/27 · hipaa notebook memphis family medicine 10 main street...

Created with the HIPAA Lifeguard App by ClinicNerds.com

HIPAA Notebook

Memphis Family Medicine10 Main Street

Memphis, TN 38101

Note: This is a sample HIPAA Notebook created by the HIPAA

Lifeguard App. The notebook layout is real but the data is

imaginary.

Memphis Family Medicine

Table of Contents

HIPAA Notebook Cover PageTable of ContentsDesignate HIPAA LifeguardPHI Hotspots ReportRooms, Doors, Floorplans

Room PhotosDoor Photos

Networks, Software, Network DiagramsNetwork Provider PhotosSoftware App Photos

Business Owned EquipmentWorkers & Personal EquipmentBusiness PartnersLegal Notes from Clinic Nerds

Designate HIPAA Lifeguard


Memphis, TN 38101

Effective January 1, 2017, the owners of Memphis Family Medicine do officially designate the HIPAA Lifeguard to be Kim Kimball.

Clinic Owners

Dr Ann Anderson

Dr Bob Brooks

Legal Reference

CFR § 164.530 Administrative requirements.

(a)

(1) Standard: Personnel designations.

(i) A covered entity must designate a privacy official who is responsible for the development and implementation of the

policies and procedures of the entity.

(ii) A covered entity must designate a contact person or office who is responsible for receiving complaints under this

section and who is able to provide further information about matters covered by the notice required by § 164.520.

(2) Implementation specification: Personnel designations. A covered entity must document the personnel designations in

paragraph (a)(1) of this section as required by paragraph (j) of this section.

Note: The HIPAA Lifeguard might also be known as the Privacy Officer, the Security Officer, the Compliance Officer or the HIPAA Officer.

HIPAA Lifeguard: Kim Kimball

PHI Hotspots Report


Memphis, TN 38101

HIPAA Lifeguard: Kim Kimball

The clinic's risk assessment identified the following PHI Hotspots. PHI Hotspots (people, places, things) should be well known to allmembers of the clinic workforce. This report is reviewed monthly by the HIPAA Lifeguard. The HIPAA Lifeguard develops policies andprocedures to safeguard each type of PHI Hotspot.

PHI Hotspots

1. Software App — Allscripts - EMR

2. Software App — Microsoft Office - Marketing, spreadsheets

3. Business Equipment — Dell Experion 1234567 — Computer, Desktop computer, Reception Room

4. Business Equipment — Dell Experion 1234555 — Computer, Desktop Computer, Admin Office

5. Business Equipment — Dell Experion 1234565 — Computer, Desktop computer, Office 1

6. Business Equipment — Dell Experion 1234564 — Computer, Dell, Admin Office

7. Business Equipment — Dell Experion 1234563 — Computer, Desktop computer, Office 2

8. Business Equipment — Brother 575 1234567 — Business, Fax, Admin Office

9. Business Equipment — Canon Image Runner 1234567 — Business, Copier, Admin Office

10. Business Equipment — Linksys Wrt1000 1234567 — Computer, Wifi router, Admin Office

11. Business Equipment — Motorola SB6000 1234567 — Computer, Modem, Admin Office

12. Business Equipment — First Data FD410-DW 1234567 — Business, Credit card reader, Admin Office

13. Workforce — Dr Ann Anderson — Doctor owner clinicial

14. Workforce — Dr Bob Brooks — Doctor owner clinicial

15. Workforce — Kim Kimball — Office Manager manager admin

16. Workforce — Nancy Nance — Nurse clinicial

17. Workforce — Paul Paulson — Physician Assistant clinicial

18. Workforce — Rhonda Robinson — Receptionist admin

19. Workforce — Thom Thompson — Admin admin

20. Workforce — Tina Turner — Medical Biller admin

21. Personal Equipment — Anderson's Lenovo Thinkpad — Computer, Laptop

22. Personal Equipment — Kimball's Apple MacBook — Computer, Laptop

23. Personal Equipment — Brooks's Apple iPad — Computer, Tablet

24. Personal Equipment — Turner's HP Spectre — Computer, Laptop

25. Personal Equipment — Nance's Samsung Galaxy — Computer, Smartphone

26. Personal Equipment — Robinson's Apple iPhone — Computer, Smartphone

27. Business Partner — Adams Accounting - Accountant

28. Business Partner — Billing by Betty - Medical Coding and Billing

29. Business Partner — Manny's Medical Waste - waste management

Not PHI Hotspots

Areas without PHI are listed in this section: Not PHI Hotspots. Transient, temporary or mobile PHI does not make an area a PHIHotspot. For example, if a PHI Hotspot like a laptop is temporarily in the breakroom, it does not make the breakroom a PHI Hotspot.

1. Room — Admin Office

2. Room — Break room

3. Room — Exam Room 1




7. Room — Front Desk

8. Room — Office 1

9. Room — Office 2

10. Room — Pre Exam Area

11. Room — Reception Room

12. Room — Restroom

13. Room — Storage Closet

14. Door — Admin Office Door

15. Door — Bathroom Door

16. Door — Emergency Exit Door

17. Door — Exam 1 door




21. Door — Front Door

22. Door — Office 1 door

23. Door — Office 2 door

24. Door — Reception room door

25. Door — Storage Closet Door

26. Network Provider — AT&T - telephone

27. Network Provider — Comcast Cable - internet

28. Business Partner — Clarence's Cleaning - Office cleaning services

The clinic must have a policy and procedure for safeguarding PHI Hotspots and for handling PHI breaches. Small PHI breaches must be reported anually to the HIPAA

Police. Large PHI breaches (affecting 500+ patients) must be reported within 60 days to the HIPAA Police, to the patients affected and to the press.

Rooms, Doors & Floorplans


Memphis, TN 38101

Rooms

1. Admin Office

Back office

2. Break room

Staff break area

3. Exam Room 1

4. Exam Room 2

5. Exam Room 3

6. Exam Room 4

7. Front Desk

Used by receptionist

8. Office 1

Dr Anderson

9. Office 2

Dr Brooks

10. Pre Exam Area

Nurse clinicians do pre exam weigh in etc

11. Reception Room

Reception desk and waiting area

12. Restroom

13. Storage Closet

Office supplies

Doors

1. Admin Office Door

2. Bathroom Door

3. Emergency Exit Door

alarm sounds when opened - opens into parking lot

4. Exam 1 door

5. Exam 2 door

6. Exam 3 door

7. Exam 4 door

8. Front Door

opens into reception room

9. Office 1 door

10. Office 2 door

11. Reception room door

reception room into pre-exam nurse area

12. Storage Closet Door


Floorplans


Admin Office

Break room

Exam Room 1

Exam Room 2

Exam Room 3 Exam Room 4

Room Photos

Total Room Photos → 12


Office 1

Office 2

Pre Exam Area

Reception Room

Restroom

Storage Closet

Room Photos

Total Room Photos → 12


Admin Office Door

Emergency Exit Door

Exam 1 door

Exam 2 door

Exam 3 door Exam 4 door

Door Photos

Total Door Photos → 10


Reception room door

Front Door

Office 1 door Office 2 door

Door Photos

Total Door Photos → 10

Networks, Software & Network Diagrams


Memphis, TN 38101

Network Providers

1. AT&T

telephone

2. Comcast Cable

internet

Software Apps

1. Allscripts

EMR 1.5

2. Microsoft Office

Marketing, spreadsheets 8.4


Network Diagrams


AT&T - telephone

Comcast Cable - internet

Network Provider Photos

Total Network Provider Photos → 2


Allscripts - EMR

Software App Photos

Total Software App Photos → 1

Business Owned Equipment


Memphis, TN 38101

1. Reception Room - Computer - Desktop computer Dell Experion 1234567

2. Admin Office - Computer - Desktop Computer Dell Experion 1234555

3. Office 1 - Computer - Desktop computer Dell Experion 1234565

4. Admin Office - Computer - Dell Dell Experion 1234564

5. Office 2 - Computer - Desktop computer Dell Experion 1234563

6. Admin Office - Business - Fax Brother 575 1234567

7. Admin Office - Business - Copier Canon Image Runner 1234567

8. Admin Office - Computer - Wifi router Linksys Wrt1000 1234567

9. Admin Office - Computer - Modem Motorola SB6000 1234567

10. Admin Office - Business - Credit card reader First Data FD410-DW 1234567


Equipment Room LocationReception Room

CategoryComputer

Equipment TypeDesktop computer

ManufacturerDell

ModelExperion

Serial Number1234567

Date Purchased2007-05-17

Equipment Features Network Connection

Memory Hard Drive

Mobile Device

NerdSecured Features Automatic check for security updates

Automatic screen lock

Separate user accounts

Sentence Based Passwords

Encrypted Hard Drive

Business Equipment DetailsDell Experion 1234567

:( no photos of Dell Experion 1234567

™


Equipment Room LocationAdmin Office

CategoryComputer

Equipment TypeDesktop Computer

ManufacturerDell

ModelExperion




Memory Hard Drive

Mobile Device








™


Equipment Room LocationOffice 1

CategoryComputer


ManufacturerDell

ModelExperion




Memory Hard Drive

Mobile Device








™



CategoryComputer

Equipment TypeDell

ManufacturerDell

ModelExperion




Memory Hard Drive

Mobile Device








™


Equipment Room LocationOffice 2

CategoryComputer


ManufacturerDell

ModelExperion




Memory Hard Drive

Mobile Device








™



CategoryBusiness

Equipment TypeFax

ManufacturerBrother

Model575




Memory Hard Drive

Mobile Device

Brother 575

1234567

Business Equipment DetailsBrother 575 1234567



CategoryBusiness

Equipment TypeCopier

ManufacturerCanon

ModelImage Runner




Memory Hard Drive

Mobile Device

Canon Image

Runner

1234567

Business Equipment DetailsCanon Image Runner 1234567



CategoryComputer

Equipment TypeWifi router

ManufacturerLinksys

ModelWrt1000




Memory Hard Drive

Mobile Device






Linksys

Wrt1000

1234567

Business Equipment DetailsLinksys Wrt1000 1234567

™



CategoryComputer

Equipment TypeModem

ManufacturerMotorola

ModelSB6000




Memory Hard Drive

Mobile Device






Motorola

SB6000

1234567

Business Equipment DetailsMotorola SB6000 1234567

™



CategoryBusiness

Equipment TypeCredit card reader

ManufacturerFirst Data

ModelFD410-DW




Memory Hard Drive

Mobile Device

First Data

FD410-DW

1234567

Business Equipment DetailsFirst Data FD410-DW 1234567

Workers & Personal Equipment


Memphis, TN 38101

1. Dr Ann Anderson

Anderson's Lenovo Thinkpad

2. Dr Bob Brooks

Brooks's Apple iPad

3. Kim Kimball

Kimball's Apple MacBook

4. Nancy Nance

Nance's Samsung Galaxy

5. Paul Paulson

6. Rhonda Robinson

Robinson's Apple iPhone

7. Thom Thompson

8. Tina Turner

Turner's HP Spectre


TitleDr

First NameAnn

Middle NameA

Last NameAnderson

Suffix Name

CredentialsMD

Job TitleDoctor

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid

CommunicationResources

Phone

Voicemail

Email

Other WorkforceCategories

Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility

Has User Id on these systems:

Electronic Medical Record System

Electronic Prescribing System

Practice Management System

Digital Imaging System

Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment

Interacts with these Business Associates:

Transcription Service

Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsDr Ann Anderson


Anderson'sLenovoThinkpad

Photos Associated With Dr Ann Anderson


Equipment Owner

Dr Ann Anderson

Category

Computer

Equipment Type

Laptop

Manufacturer

Lenovo

Model

Thinkpad

Serial Number

7654321

Date Purchased

2015-05-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device

NerdSecured Features

Automatic check for security updates





Personal Equipment DetailsAnderson's Lenovo Thinkpad

™


TitleDr

First NameBob

Middle NameB

Last NameBrooks

Suffix NameJr

CredentialsDO

Job TitleDoctor

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsDr Bob Brooks


Brooks's AppleiPad

Photos Associated With Dr Bob Brooks


Equipment Owner

Dr Bob Brooks

Category

Computer

Equipment Type

Tablet

Manufacturer

Apple

Model

iPad

Serial Number

1234567

Date Purchased

2015-05-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device







Personal Equipment DetailsBrooks's Apple iPad

™


Title

First NameKim

Middle NameK

Last NameKimball

Suffix Name

CredentialsCMM

Job TitleOffice Manager

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsKim Kimball


Kimball's AppleMacBook

Photos Associated With Kim Kimball


Equipment Owner

Kim Kimball

Category

Computer

Equipment Type

Laptop

Manufacturer

Apple

Model

MacBook

Serial Number

1234567

Date Purchased

2015-05-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device







Personal Equipment DetailsKimball's Apple MacBook

™


Title

First NameNancy

Middle NameN

Last NameNance

Suffix Name

CredentialsRN

Job TitleNurse

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsNancy Nance


Nance'sSamsungGalaxy

Photos Associated With Nancy Nance


Equipment Owner

Nancy Nance

Category

Computer

Equipment Type

Smartphone

Manufacturer

Samsung

Model

Galaxy

Serial Number

1234567

Date Purchased

2015-12-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device







Personal Equipment DetailsNance's Samsung Galaxy

™


Title

First NamePaul

Middle NameP

Last NamePaulson

Suffix Name

CredentialsPA-C

Job TitlePhysician Assistant

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsPaul Paulson


Photos Associated With Paul Paulson

no worker related photos :(


Title

First NameRhonda

Middle NameR

Last NameRobinson

Suffix Name

Credentials

Job TitleReceptionist

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsRhonda Robinson


Robinson'sApple iPhone

Photos Associated With Rhonda Robinson


Equipment Owner

Rhonda Robinson

Category

Computer

Equipment Type

Smartphone

Manufacturer

Apple

Model

iPhone

Serial Number

1234567

Date Purchased

2016-10-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device







Personal Equipment DetailsRobinson's Apple iPhone

™


Title

First NameThom

Middle NameT

Last NameThompson

Suffix Name

Credentials

Job TitleAdmin

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsThom Thompson


Photos Associated With Thom Thompson

no worker related photos :(


Title

First NameTina

Middle NameT

Last NameTurner

Suffix Name

CredentialsCPB

Job TitleMedical Biller

Owner

Manager

Employee

Role Type

Clinical

Admin

Maintenance

Other

Schedule

Full-Time

Part-Time

Per-Diem

Other

Compensation

Paid

Unpaid


Phone

Voicemail

Email


Resident

Intern/Stu

Substitute

Trainee

Volunteer

On Call

PHI Accessibility






Equipment Access:

Medical Equipment

Business Equipment

Computer Equipment



Medical Coders

Medical Billers

Accountant

Payroll Service

Law Firm / Lawyer

Translation Service

Workforce DetailsTina Turner


Turner's HP

Spectre

Photos Associated With Tina Turner


Equipment Owner

Tina Turner

Category

Computer

Equipment Type

Laptop

Manufacturer

HP

Model

Spectre

Serial Number

1234567

Date Purchased

2015-03-26

Equipment Features

Network Connection

Memory Hard Drive

Mobile Device







Personal Equipment Details

Turner's HP Spectre

™

Business Partners


Memphis, TN 38101

1. Adams Accounting - Accountant

2. Billing by Betty - Medical Coding and Billing

3. Clarence's Cleaning - Office cleaning services

4. Manny's Medical Waste - waste management


NameAdams Accounting

Service ProvidedAccountant

Business Associate Agreement

Primary ContactNameJohn Adams

Phone901-234-5678

[email protected]

Address10 Main St Memphis, TN 38002

Business Partner DetailsAdams Accounting - Accountant

:( no photos of Adams Accounting - Accountant


NameBilling by Betty

Service ProvidedMedical Coding and Billing


Primary ContactNameBetty Billingsham

Phone901-321-7788

[email protected]


Business Partner DetailsBilling by Betty - Medical Coding and Billing

:( no photos of Billing by Betty - Medical Coding and Billing


NameClarence's Cleaning

Service ProvidedOffice cleaning services


Primary ContactNameClarence Coleman

Phone901-342-8877

[email protected]

Address13 Main St

Memphis, TN 38002

Business Partner Details

Clarence's Cleaning - Office cleaning services

:( no photos of Clarence's Cleaning - Office cleaning services


NameManny's Medical Waste

Service Providedwaste management


Primary ContactNameManny Manning

Phone901-543-3321

[email protected]


Business Partner DetailsManny's Medical Waste - waste management

:( no photos of Manny's Medical Waste - waste management

Legal DisclaimerThe HIPAA Lifeguard App and the HIPAA Notebook document do not constitute legal advice. The materials available atthis web site are for informational purposes only and not for the purpose of providing legal advice. You should contactyour attorney to obtain advice with respect to any particular issue or problem. Use of and access to this Web site do notcreate an attorney-client relationship between Clinic Nerds and the user or browser.

Clinic Nerds has trademarks, servicemarks, and/or copyrights on the following:

HIPAA LifeguardPHI HotspotsNerdSecuredHIPAA Outlaws

All trademarks, service marks and trade names of Clinic Nerds used in the website are trademarks or registeredtrademarks of Clinic Nerds. They may not be used without our prior written permission. Any other intellectual property inthe website, including but not limited to patents, issued or pending, are the sole property of Clinic Nerds.

Printed: 2017-05-27 22:18:15 UTC.

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hipaa notebook - amazon s3...2017/05/27 · hipaa notebook memphis family medicine 10 main street...

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