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What is HL7?

Health Level-7 or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is “layer 7” in the OSI model. The HL7 standards are produced by the Health Level Seven International, an international standards organization, and are adopted by other standards issuing bodies such as American National Standards Institute and International Organization for Standardization.

Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or “interface”) when they receive new information, or when they wish to retrieve information, but not all do so.

HL7 International specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information. Theoretically, this ability to exchange information should help to minimize the tendency for medical care to be geographically isolated and highly variable.

HL7 International considers the following standards to be its primary standards – those standards that are most commonly used and implemented:

  • Version 2.x Messaging Standard – an interoperability specification for health and medical transactions
  • Version 3 Messaging Standard – an interoperability specification for health and medical transactions
  • Clinical Document Architecture (CDA) – an exchange model for clinical documents, based on HL7 Version 3
  • Continuity of Care Document (CCD) – a US specification for the exchange of medical summaries, based on CDA.
  • Structured Product Labeling (SPL) – the published information that accompanies a medicine, based on HL7 Version 3
  • Clinical Context Object Workgroup (CCOW) – an interoperability specification for the visual integration of user applications

Other HL7 standards/methodologies include:

  • Fast Healthcare Interoperability Resources (FHIR) – a draft standard for the exchange of resources
  • Arden Syntax – a grammar for representing medical conditions and recommendations as a Medical Logic Module (MLM)
  • Claims Attachments – a Standard Healthcare Attachment to augment another healthcare transaction
  • Functional Specification of Electronic Health Record (EHR) / Personal Health Record (PHR) systems – a standardized description of health and medical functions sought for or available in such software applications
  • GELLO – a standard expression language used for clinical decision support

What is XEVPRM and what is an EV Code?

XEVPRM stands for Extended EudraVigilance Product Report Message. It defines the structure, layout and contents of the file that must be sent to the EMA to populate the XEVMPD. This is a very IT-technical thing that can’t realistically be created manually.

XEVPRM is based on XML files like the eCTD is. XML stands for Extensible Mark-up Language and it’s a way to send structured data around the Internet, a bit like how HTML is the ‘language’ that web sites use to display text and graphics.

How does it work?

Basically your software will gather together all your product licence information and any related data about organisations etc, put it into XML format, and create a ZIP file from it, along with any documents that are also required. Each XML file or document must be less than 25MB and the overall ZIP file must be less than 60MB. You will then send this to the EMA in one of two ways;

  • using your Gateway (if you have one)
  • or by logging on to EVWEB and using EV WEB Trader Post function to upload and send the file.

Once the EMA receive the file they will process it according to their published rules;

  • first their software will check that the XML file structure matches their definition;
  • then it will check that their business rules have been obeyed;
  • next it will update their database with your valid information, and generate EV Codes for the new records;
  • then it will create an acknowledgement file (called an XEVPRM_ACK) that will say which data it found to be valid and which is invalid;
  • finally it sends the file back to you using Gateway or EVWEB.

Your software will then read this file and use it to update your database with the EV Codes that it has allocated to your data.

What’s an EV Code?

The EV Code is the unique reference for your product (etc) information in their database. When you first send a new record to the EVMPD (a new product licence for example) your software will send it using your local system’s unique key (for example it might be record number 1234 in your system). The EMA will add a new record to their database for this record and allocate it a unique key from their side, for example PRD0005678, and this will be sent back in the acknowledgement file. Your software will then update the EV Code in your database with this information. From then on, whenever a record needs to be updated, your software will send the EV Code in order to identify the record concerned.

Does eMEDICS.org support EMA forms?

YES.

The European Medicines Agency (EMA) is a decentralized agency of the European Union, located in London. The Agency is responsible for the scientific evaluation of medicines developed by pharmaceutical companies for use in the European Union. It began operating in 1995. Here are some sample forms that we have implemented:

Policy on access to EMA documents

In November 2010, the Agency published a policy on how these rules should be implemented for documents relating to medicines for human and veterinary use. The policy came into force at the time of publication. It gives wider access to documents held by the Agency than ever before, allowing access to all business-related documents unless there is a need to respect arrangements for regulators outside the EU or international organisations, or to protect the privacy and integrity of a natural or legal person. The policy was adopted following a public consultation and took recommendations made by the European Ombudsman into account.

As a general rule, the Agency releases documents once a procedure concerning a medicine has been finalised. This protects the decision-making process. The policy is accompanied by a listing of the level of confidentiality that applies to the types of document produced by the Agency.

How to submit a request

Access-to-documents requests should be submitted by completing the online EMA form

What is InterRAI?

interRAI is an international collaborative to improve the quality of life of vulnerable persons through a seamless comprehensive assessment system.

interRAI consortium strives to promote evidence-informed clinical practice and policy decision making through the collection and interpretation of high-quality data about the characteristics and outcomes of persons served across a variety of health and social services settings.

interRAI instruments have been adopted around the world, bringing a standard level of care to geriatric and disabled populations.

Speaking the same language for high quality care  (Acute Care form, Assisted Living form, Child and Youth Intellectual/Developmental Disability form, Child and Youth Mental Health form, Community Health Assessment form, Community Mental Health form, Contact Assessment form, Deafblind form, Emergency Screener form, Home Care form, Intellectual Disability form, Long-Term Care Facilities form, Mental Health for Correctional Facilities form, Mental Health for In-Patient Psychiatry form, Palliative Care form, Post-Acute Care form, Quality of Life form, Wellness form.

he Comprehensive Clinical Assessment Project is about establishing the use of a standardized assessment tool, that uses software, designed to improve the care of older people in residential care facilities.

Developed by the interRAI network of health researchers in over 30 countries, this tool is a comprehensive clinical assessment of medical, rehabilitation and support needs and abilities such as mobility and self-care. This information helps nurses to write tailor-made care plans which, when implemented benefit both residents and staff.

New Zealand is the first country in the world to have a national implementation of this tool. This means this country will soon have detailed statistical information about the needs of older people in the community and in care.

Benefits

The Comprehensive Clinical Assessment (interRAI) tool:

  • Provides a comprehensive clinical assessment of a person’s medical, rehabilitation and support needs and abilities such as mobility and self-care
  • Provides information to help nurses write tailor-made care plans which, when implemented, benefit both older people and staff.
  • Allows an older person’s family to be part of the assessment process so they know that their family member’s needs have been identified and catered for by the rest home facility.
  • Allows for comparing data on residents with similar needs within a facility or within a chain of facilities, so a standardized ‘best practice’ approach to providing care can be used.
  • Will allow the Ministry of Health to access data on how older people are doing in rest homes, and in the community, to identify any trends or gaps so that health policy can be developed which addresses healthcare needs.

 

Does eMEDICS.org support FDA forms?

YES.

FDA (Food and Drug Administration) is responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

FDA is also responsible for advancing the public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. FDA also has responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors.

Finally, FDA plays a significant role in the Nation’s counter terrorism capability. FDA fulfills this responsibility by ensuring the security of the food supply and by fostering development of medical products to respond to deliberate and naturally emerging public health threats.

Most of the FDA forms are organized as follow:

  • Investigational New Drug Forms (IND),
  • New Drug Application Forms (NDA),
  • Abbreviated New Drug ,  Application Forms (ANDA) for Generic Drug Products,
  • Orphan Drug Products (for rare diseases and disorders),
  • Electronic Regulatory Submission and Review (ERSR).

They could be found under the FDA web site.

Here are some samples of FDA forms that we have been implementing:

 

What does CRF mean?

The Case Report Form (CRF) is the data collection tool for the clinical trial and can be paper or electronic. Paper CRFs will be printed, often using No Carbon Required paper, and shipped to the investigative sites conducting theclinical trial for completion after which they are couriered back to Data Management. Electronic CRFs enable data to be typed directly into fields using a computer and transmitted electronically to Data Management. Design of CRFs needs to take into account the information required to be collected by the clinical trial protocol and intended to be included in statistical analysis. Where available, standard CRF pages may be re-used for collection of data which is common across most clinical trials e.g. subject demographics. Apart from CRF design, electronic trial design also includes edit check programming. Edit checks are used to fire a query message when discrepant data is entered, to map certain data points from one CRF to the other, to calculate certain fields like Subject’s Age, BMI etc.. Edit checks help the investigators to enter the right data right at the moment data is entered and also help in increasing the quality of the Clinical trial data.

Our Clinical Data Management capabilities Include:

  • Case report form (CRF) design, production and tracking
  • Custom database generation
  • CRF review
  • Data entry with quality control
  • Automatic edit checking and query tracking
  • Data cleaning
  • Electronic data transfers from 3rd parties (e.g. central lab, PK, ECG data)
  • Superior quality control and assurance
  • Rapid database closure

eMEDICS.org supports various CRF forms. Some are listed under the OpenClinica.com library.

Among them: Adverse Event forms, Prior and Concomitant Medications forms, Demographics forms, ECG Test Results forms, Laboratory Test Results forms, Medical History forms, Physical Examination forms and Vital Signs forms.

Any Administrative form samples?

YES.

Building online forms can be fastidious. Some great form builders are available on the market but do not provide an end to end solution. For instance, they do not always support the offline mode nor automatically push your data to the back-end (data base, flat file, PDF, email…). Our solution creates your forms and the back-end simultaneously for a fraction of the cost, so that you don’t have to worry about anything except your data. We can help you create contact forms, online surveys and invitations so you can collect the data, registrations and payments you need. Our web and mobile app supports the offline mode, an automated data synchronization with the back office and any kind of data field: single line text, paragraph text, multiple choice, section break, number, check-boxes, drop down, page break, name, address, email, phone, price, rating, file upload, time, date, charts, arrays and historical data…

eMEDICS.org has already implemented a significant amount of forms (ex: RAI-MDS evaluation forms, FDA & EMA submission forms) that you could easily re-use at no cost. We have also implemented various administrative forms. Some have been integrated to SharePoint, Documentum, Confluence or some other Document Management tools and Content Management Systems (CMSs). See below some basic SharePoint sample forms that have been easily migrated to our mobile app:

Permissions and access control

Permissions (and the related concept of access control lists, or ACLs) are collections of rules which define access to various areas of the forms. In essence, we create roles for your forms, give these roles permissions to do certain things, and assign the roles to certain people.

Permissions and ACLs allow you to grant access to:

  • Different areas of your forms to reflect the tasks the user is responsible for
  • Entities within the system (like contacts, contributions, etc.), and how the user can interact or operate with them (e.g. view, edit, delete)

Since permissions define who can see and do what on your forms, it is important, from a security perspective, that you understand them well. It is very easy to check a permissions box without fully understanding what it does. A form with badly configured permissions may inadvertently expose your contacts’ data.

Other administrative form

Here is a list of forms that we could easily be implemented: Surveys, Medical evaluation form, Courses and Curricula, Environment Health and Safety Office, Financial Services, Travel form, Accounts payable form, Leave Documents, Legal, Memos, Payroll, Policies, Purchasing, Workers compensation, All Hiring forms, Change of Address forms, Clearance form for employees terminating employment, Holiday schedules, Resignation form, Saving bonds form, Performance planning and review form, Violence checklist, Violence incident statement, Accident report, Bio lab safety report, Lab inspection, Grounds inspection report, Fire safety report, Office evacuation report, Work area inspection form, Work request form…

Do we support ASCO forms?

YES. Here are some examples of forms that have been successfully implemented:
ASCO Medical Forms – ASCO Cancer Treatment medical forms. ASCO Cancer Treatment Summaries are Find forms provided as Word documents that your doctor can complete to help you keep track of what treatment is planned after surgery, what treatment you received, and a summary of your follow-up care plan once treatment is finished. To download a treatment summary to your computer, right-click on the link and select “Save As.” None of these forms are intended to provide a complete medical record, and no single treatment plan or summary is appropriate for all patients. Patients are encouraged to discuss all treatment options and follow-up care plans with their doctor. The ASCO Treatment Plan and Summary should be used with the guidance of your doctor. Learn more about the ASCO Treatment Plans and Summaries.

What’s a RAI-MDS

An assessment tool, including a set of assessment items, clinical assessment protocols, and outcome reports by the Centre for Health Systems Research and Analysis at the University of Wisconsin designed to improve the quality of clinical needs assessments and care planning for Personal Care Home (PCH) residents. This instrument has been mandated for use by PCHs in the United States, and is also being utilized currently by select provinces in Canada, as well as by the WRHA in Manitoba. Minimum Data Set (MDS) data are a component of the RAI-MDS designed to report function and cognitive performance, indicators of social supports, and other resident characteristics.

RAI-MDS practice requirements for Long-Term Care Homes consists of:
  1. The Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 is the standardized assessment tool for admission, quarterly, significant change in health status and annual assessments for each resident.
  2. The use of other assessment tools, in addition to RAI-MDS 2.0 should only be necessary following the MDS assessment and Resident Assessment Protocols (RAPs) analysis when clinicians, based on their clinical judgment, make a decision to make a referral and/or conduct further assessment for the development of a comprehensive resident plan of care.
  3. The Minimum Data Set (MDS) and Resident Assessment Protocols (RAPs) cannot be completed prior to the Assessment Reference Date (ARD). The ARD is the last day of the observation period. The ARD should be set with input from the interdisciplinary care team.
  4. Each new resident must be assessed by the interdisciplinary care team using the MDS 2.0 Full Assessment within 14 days of admission.
  5. Each resident’s care and service needs shall be reassessed using the MDS 2.0 Quarterly or Full Assessment by the interdisciplinary team within 92 days of the ARD of the previous assessment.
  6. Any significant change in resident’s condition, either decline or improvement, shall be reassessed along with RAPs by the interdisciplinary care team using the MDS Full Assessment by the 14th day following the determination that a significant change in status has occurred.
  7. A ‘significant change in the resident’s health status’ resulting in the completion of a Full MDS Assessment in the same quarter in which the annual or quarterly assessment is due, may replace the quarterly or annual assessment for that period.
  8. Criteria for determining a significant change in status is identified in the Resident Assessment Instrument (RAI) MDS 2.0 and RAPs Canadian Version User’s Manual, Second Edition, March 2005, pp 3-7, 3-8, 3-9.
  9. For new admissions:
    • A written plan of care shall be initiated for each new resident within 24 hours of admission and be finalized by the interdisciplinary care team by day 21 maximum from admission or 7 days maximum after the date at VB2.
    • Resident assessment protocols (RAPs) must be generated and reviewed and RAPs assessment summaries must be completed for triggered RAPS and non-triggered clinical conditions by day 14 maximum.
    • 10. For all other assessments (quarterly, significant change in the resident’s health status)
  10. A written plan of care shall be initiated for each new resident within 24 hours of admission and be finalized by the interdisciplinary care team by day 21 maximum from admission or 7 days maximum after the date at VB2. The care plan must be reviewed by the interdisciplinary care team and where necessary revised, within 14 days of the assessment ARD or within 7 days maximum following the date at VB2. RAPs must be generated and reviewed and RAPs assessment summaries must be completed for triggered RAPs and non-triggered clinical conditions within 7 days maximum of the Assessment Reference Date (ARD).
  11. Where a significant change in the resident’s health has resulted in the completion of a Full Assessment, then the Full Assessment may replace the Quarterly Assessment for that quarter.
  12. Each resident is assessed annually by the interdisciplinary care team using the MDS Full Assessment within 366 days of the ARD of the previous Full Assessment, along with RAPs and care plan review and update.
  13. The MDS 2.0 assessment instrument is a primary source document and includes the following requirements: A) With the exception of medical diagnoses, test results or examinations, physician orders, nursing rehabilitation and therapies, duplicate documentation is not required to support all MDS assessment items, B) RAI-MDS 2.0 assessment information comes from multiple sources: observations, review of clinical records, plans of care, as well as interviews with the resident, significant others
    and team members, C) The MDS assessment and RAI outputs (outcome scales, quality indicators) identify actual and potential resident care needs and provide the evidence on which to conduct the critical analysis of RAPs and to base decisions related to care planning.
  14. For quarterly and significant change in status assessments that do not take the place of the full
    annual assessment, the following standard statement may be used for ‘existing’ triggered RAPs
    that have no clinical and/or care plan changes.
  15. For the initial admission and annual full assessments, all RAPs must be reviewed and treated as new and no standard statement may be used.
  16. Care plan interventions shall be implemented and evaluated for their effectiveness. There shall be evidence in the health care record to support the decision for no changes in the plan of care.
  17. The RAPs assessment summaries and plan of care for triggered RAPs may be combined, if the goals of care, risk factors, care interventions, and treatments are all interrelated. Combined RAPs assessment summaries and plan of care may be used for comprehensive admission, quarterly, annual and/or significant change in health status assessment.

What’s an EMR

An electronic health record (EHR), or electronic medical record (EMR), is a systematic collection of electronic health information about an individual patient or population.

An EMR contains the standard medical and clinical data gathered in one provider’s office. EHRs go beyond the data collected in the provider’s office and include a more comprehensive patient history.For example, EHRs are designed to contain and share information from all providers involved in a patient’s care. EHR data can be created, managed, and consulted by authorized providers and staff from across more than one health care organization.

Unlike EMRs, EHRs also allow a patient’s health record to move with them—to other health care providers, specialists, hospitals, nursing homes, and even across states.

An electronic medical record (EMR) is a digital version of a paper chart that contains all of a patient’s medical history from one practice. An EMR is mostly used by providers for diagnosis and treatment.

Benefits of Electronic Medical Records

An EMR is more beneficial than paper records because it allows providers to:

  • Track data over time
  • Identify patients who are due for preventive visits and screenings
  • Monitor how patients measure up to certain parameters, such as vaccinations and blood pressure readings
  • Improve overall quality of care in a practice

The information stored in EMRs is not easily shared with providers outside of a practice. A patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team.

EMR and Practice Management solutions are designed to help enhance the clinical and financial productivity. EMR modules may be used independently:

Customizability
EMR solution should be tailored to your unique workflow and preferences, enabling you to practice medicine more effectively in the way you prefer.

Seamless interoperability
Whether you need a fully integrated EMR and Practice Management solution or the ability to share data with existing clinical or financial systems, EMR solution should connect when, where, and how you need it to.

Progressive technology
EMR solution should be built with progressive technologies to help you adapt to regulatory changes (ex: integrated Meaningful Use toolkit helps you successfully prepare for attestation.

What information can be found in my health record

health record is created any time you see a health professional such as a doctor, nurse, dentist, chiropractor, or psychiatrist. You could find the following in your health record:

  • Your medical history and your family’s medical history
  • Labs and x-rays
  • Medications prescribed
  • Alcohol use and sexual activity
  • Details about your lifestyle (smoking, exercise, recreational drug use, high-risk sports, stress levels)
  • Doctor/nurse notes
  • Results of operations and procedures Genetic testing
  • Research participation
  • Any Information you provide on applications for disability, life or accidental insurance with private insurers or government programs
  • Driver’s License
  • Social Security Number
  • Financial information such as credit cards and payment info.

You’ve probably seen your chart at your doctor’s office. In fact, you may have charts at several doctors’ offices. If you’ve been in the hospital, you have a chart there, too. These charts are your medical records. They may be on paper or electronic. To keep track of all this information, it’s a good idea to keep your own personal health record.

What kind of information would you put in a personal health record? You could start with

  • Your name, birth date, blood type, and emergency contact information
  • Date of last physical
  • Dates and results of tests and screenings
  • Major illnesses and surgeries, with dates
  • A list of your medicines and supplements, the dosages, and how long you’ve taken them
  • Any allergies
  • Any chronic diseases
  • Any history of illnesses in your family

VIVATES eHealth

Swiss Post has always actively contributed innovative solutions to the electronic health sector. The vivates Service Portfolio facilitates the exchange of patient data between healthcare professionals.

Swiss Post is committed to extending electronic healthcare services with its innovative products and services. As one of the pioneers in the e-health sector, it has joined forces with the canton of Geneva to come up with the first nationwide electronic patient record in compliance with Switzerland’s eHealth strategy. Several cantons already place their trust in the secure electronic health solutions from Swiss Post.

Secure exchange of patient data

The eHealth service from Swiss Post features a comprehensive, modular service portfolio. The vivates service modules meet the specific requirements of the various healthcare professionals, from simple transfer and swift exchange to patient data archiving.

Hospitals, physicians, pharmacies, outpatient organizations, care personnel, laboratories and other professionals benefit from the secure, efficient and transparent handling of data – for the good of the patients. Patients can view their data at any time and decide themselves who may access their data and to what extent.

Data protection and the security of the access processes are guaranteed at all times. Swiss Post uses state-of-the-art technology and complies fully with the legal requirements for data processing.

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What’s an ERP

Enterprise resource planning (ERP) is defined as the ability to deliver an integrated suite of business applications. ERP tools share a common process and data model, covering broad and deep operational end-to-end processes, such as those found in finance, HR, distribution, manufacturing, service and the supply chain. It is business process management software that allows an organization to use a system of integrated applications to manage the business and automate many back office functions related to technology, services and human resources.

ERP software integrates all facets of an operation, including product planning, development, manufacturing, sales and marketing. It is considered an enterprise application as it is designed to be used by larger businesses and often requires dedicated teams to customize and analyze the data and to handle upgrades and deployment. In contrast, small business ERP applications are lightweight business management software solutions, customized for the business industry you work in.

Top ERP Trends

The ERP field can be slow to change, but the last couple of years have unleashed forces which are fundamentally shifting the entire area. According to Enterprise Apps Today, the following new and continuing trends affect enterprise ERP software:

1. Mobile

Executives and employees want real-time access to information, regardless of where they are. It is expected that businesses will embrace mobile ERP for the reports, dashboards and to conduct key business processes.

2. Cloud

The cloud has been advancing steadily into the enterprise for some time, but many ERP users have been reluctant to place data cloud. Those reservations have gradually been evaporating, however, as the advantages of the cloud become apparent.

3. Social

There has been much hype around social media and how important – or not — it is to add to ERP systems. Certainly, vendors have been quick to seize the initiative, adding social media packages to their ERP systems with much fanfare. But some wonder if there is really much gain to be had by integrating social media with ERP.

4. Two-tier ERP

Enterprises once attempted to build an all-encompassing ERP system to take care of every aspect of organizational systems. But some expensive failures have gradually brought about a change in strategy – adopting two tiers of ERP.

Can my personal health information be used and disclosed without any notice to me or without my informed consent at the time of treatment

NO.

The Amended HIPAA Privacy Rule states only that you must receive a Privacy Notice telling you how your personal health information will be used and disclosed. Section 164.520(c) (2) (i) (A).

HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs. The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

The HIPAA Rules apply to covered entities and business associates.

Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules’ requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.

If an entity  does not meet the definition of a covered entity or business associate, it does not have to comply with the HIPAA Rules.  See definitions of “business associate” and “covered entity” at 45 CFR 160.103.

Privacy Notices are often mistaken for consent forms, but they are simply notices telling you what will happen to your medical records.

January 5, 2015 / Posted by / FAQs