Phoenix Health Systems
HIPAAction Small Provider
Assessment & Planning Toolset

For Healthcare Providers

Assessment Toolkit: Forms, Questionnaires and Resources

Compliance with HIPAA transactions, privacy and security rules typically must begin with a "gap" assessment, or comparison, of the covered entity's existing systems, policies, procedures, and practices against HIPAA's specific requirements. Once the "gaps" are inventoried, documented and analyzed, the organization is then armed with the information needed to develop a comprehensive plan to implement any changes required to ensure HIPAA compliance. This Assessment Toolkit includes user-friendly assessment forms, analysis guidelines, and planning checklists and recommendations designed to support organizational gap assessment and development of the HIPAA implementation plan.

Project Startup

Pre-Assessment Inventory
Assessment Project Action Checklist
Assessment Project Plan
Sample HIPAA Management Awareness Presentation
Sample HIPAA Team Training Presentation

Systems Assessment Tools: Transactions, Code Sets, and Identifiers

Vendor Questionnaire
Payer Questionnaire
Transactions Questionnaire
Systems Inventory and Code Sets Questionnaire
Identifiers Questionnaire
Payer Letter
Vendor Letter

Privacy Assessment Tools

Administrative Requirements Questionnaire
General Requirements Questionnaire
Authorization Review Checklist
Individual Rights Questionnaire
Notice Questionnaire
Notice Review Checklist
Organizational Requirements Checklist
Right to Restrict Questionnaire
Uses and Disclosures Questionnaire
Other Requirements Questionnaire
Assessment Interview Questionnaire

Security Assessment Tools

Physical Security Checklist
Physical Security Questionnaire
Security Administrative Questionnaire
Security Services Questionnaire
Technical Security Mechanisms Questionnaire

Business Associate Assessment Tools

Business Associate Flow
Business Associate Status Review
Business Associate Agreement Review Checklist

Assessment Analysis Tools

Assessment Report Checklist
Analysis Directions
Privacy Analysis Tool
Security Analysis Tool

Implementation Planning Tools

Transactions Planning Checklist
Security Planning Checklist
Privacy Planning Checklist

HIPAA is very complex. As a result, no simple checklist can quickly enable any organization to become HIPAA-compliant. Nor can one handbook provide all the knowledge needed to understand HIPAA and all its regulatory details. It is important that anyone embarking on a HIPAA compliance initiative reads and understands the text of the actual HIPAA regulations, in order to understand their implications for the particular organization. Copies of the most recent versions are included as a supplement to this Assessment Toolkit.