Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Annual HIPAA Privacy & Security Training

  1. Annual HIPAA Privacy & Security Training

    <span class="fr-tmp fr-em">F</span><span class="fr-tmp fr-sm">F</span><span class="fr-tmp fr-em">F</span><span class="fr-tmp fr-sm">F</span>HTML Video embed

    Please view the Training Video Below

  2. Electronic Signature Agreement*

    This is to certify that I have viewed and understand the Madison County HIPAA training presentation. I agree to comply with the HIPAA Privacy Rule and related policies and procedures, applicable to my position. This will be expected as part of my continued association. I understand that I must report any instances of possible violations of HIPAA, laws, regulations, and policies and procedures to Madison County's HIPAA Privacy Officer. I understand that my failure to comply with HIPAA, laws, regulations, and policies and procedures or to report possible violations may result in disciplinary action. Should I have any questions I will direct them to the Privacy Officer, Security Officer, Compliance Officer or my supervisor.

    Submission of this form is your legally binding acknowledgement that you have viewed the training presentation.

  3. Post-Training Quiz (Required)

    Upon completion of the training video, please answer the below questions to test your knowledge of the HIPAA Privacy and Security Rules.

  4. 1. Unauthorized access is:*
  5. 2. What does PHI stand for?*
  6. 3. Protected health information that should be kept confidential includes a patient’s: *
  7. 4. Discussions about patients or patient information in public areas, such as the break room or lobby, may be overheard by unauthorized listeners and may violate the patient’s right to privacy. *
  8. 5. You are logging into your computer first thing Monday morning. You enter your password but get a message that your log-in failed. You try again and it doesn’t work. You are positive that you are using the correct password. What do you do? *
  9. 6. How should an employee report a suspected privacy or security breach? Choose all that apply. *
  10. 7. You are at the copier and notice that patient information has been discarded in the wastebasket. What should you do?
  11. 8. As an employee of a HIPAA designated Department you must securely segregate PHI from access by or disclosure to non-HIPAA department.*
  12. Leave This Blank:

  13. This field is not part of the form submission.