Medical College of Georgia Medical College of Georgia
Division of Visual & Instructional Design
Auditoria Center, BC-129
Augusta, Georgia 30912
Phone (706) 721-3967
Web Site: www.mcg.edu/VID/
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The Medical College of Georgia
TO: VID Customers
Title of Project:
Topic:
Date:
FROM: Division of VID
RE: HIPAA Compliance
The Health Insurance Portability and Accountability Act (HIPAA) states that patient records and photos used in presentations or other projects must be stripped of all “direct identifiers” such as name, address, social security number, patient ID number, identifiable photographic images, etc or that you have written authorization from the patient to use his/her directly identifiable health information in this way. The Division of VID requires you, as the project originator, to verify by way of your signature below that your materials meet these HIPAA standards. Materials include, but are not limited to, handouts, slides, PowerPoint presentations, photos, videos and reproductions of journal articles and any other materials including protected health information (PHI).
I verify I am in compliance with the HIPAA standards to protect the privacy of the patients discussed in my project(s). I either have received written authorization from the patient, have removed any identifiable images or patient records from my project, or my project does not pertain to patient treatment.
Printed Name:
Signature: _________________________________________________ Date: