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GUIDANCE (Jan. 2007)

Available on the UC Medical Center Intranet, under the Employee Tools Tab.  Find Purchasing and click on North American Corporation.

Use the userid and password supplied to each department manager.

ITEM	PRODUCT ID	QUANTITY
HIPAA Sign-In Sheet with Removable Labels	SGNSHT	100/pk
Notice of Privacy Practices (NPP) Booklets	HIPAA Booklet	each
NPP Acknowledgement Form	10.26	100/pk
Blue Privacy Cards	Password Card	500/box

If you have questions about these supplies, please contact:

Greg Jandacek
(847) 832-4180
gjandacek@nacorporation.com

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The following are available for download from the HIPAA website's Faculty & Staff section:

IRB Forms
Authorization Forms
HIPAA Privacy Review Sample Report Form
Fax Cover Sheet
Notice of Privacy Practices Acknowledgement Form
Request for PHI for Uses Other Than Treatment and Payment (PHI Request Form)
Verification of Law Enforcement's Immediate Need of Information About a Patient Victim

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HIPAA Program Office
The University of Chicago Medical Center | 5841 South Maryland Avenue | Chicago, IL 60637
HPOwebmaster@bsd.uchicago.edu