Notice of Privacy Practices
HIPAA requires that all patients receive a Notice of Privacy Practices on their first contact with UVa after April 14, 2003. The Notice of Privacy Practices explains UVA's privacy practices regarding a patient's medical records. An acknowledgement of receipt of the UVA Notice must be obtained from all research subjects. If the subject is already a UVA patient, they may have already signed this form. You may check the A2K3 system to determine if they have signed it. If the person has not yet signed this form, the principal investigator is responsible for giving the subject the Notice and obtaining the subject's signature on the acknowledgement form. If the person has a medical record number, the medical record number should be written on the Notice and the form should be faxed to Health Information Services at 924-1290. If you do not have access to A2K3, you will need to distribute the Notice of Privacy Practices and obtain the acknowledgement from all of your subjects. If the subject has a medical record number, the form should be sent to Health Information Services as previously described. If your subjects do not have medical record numbers, then the form should be kept with the consent form in your regulatory files. These must be kept for six years from the closure date of the protocol.
This form may be ordered free of charge in English or Spanish in packs of 100 from the UVa Printing Services hospital copy center. When completing the on-line Printing Services order form, please note that the PTAEO box must be filled by entering either no charge or zeros prior to submission.
Please note: The Notice of Privacy Practices is different from the IRB-HSR Consent Form and/or the stand-alone HIPAA authorization.