HIPAA Compliance Agreement For Employees
Created by: [YOUR NAME]
Company: [YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Compliance Checklist:
Employee has received HIPAA training. | | |
Employee understands all the HIPAA regulations. | | |
Employee signed HIPAA compliance agreement. | | |
Employee awareness of penalties for non-compliance. | | |
Employee has access to appropriate data protection tools. | | |
Employee briefed on HIPAA violation reporting system. | | |
Additional Requirements:
Did your department implement HIPAA regulation updates? | | |
Are [YOUR COMPANY NAME]'s policies HIPAA compliant? | | |
Does [YOUR COMPANY NAME] securely encrypt health data? | | |
Data Handling
Did the employee undergo annual HIPAA training? | | |
Does the employee know the PHI handling/disposal process? | | |
Can the employee recognize a potential HIPAA violation? | | |
Did the employee report any HIPAA violations last year? | | |
Data Security
Are devices storing PHI encrypted? | | |
Are security patches and updates applied regularly? | | |
Is multi-factor authentication used for accessing PHI? | | |
Are there access controls in place for PHI? | | |
Incident Response
Does a documented plan exist for PHI breach responses? | | |
Are employees trained on the incident response plan? | | |
Has the incident response plan been tested? | | |
Audit and Monitoring
Is there regular auditing of access to PHI? | | |
Are logs of access to PHI monitored regularly? | | |
Are audit logs retained for the required time period? | | |
Employee's Commitment:
I, [EMPLOYEE NAME], commit to upholding [YOUR COMPANY NAME]'s HIPAA compliance regulations. I understand my responsibilities and the risks of non-compliance.

[Date Signed]
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