This "course" would be more aptly described as a downloadable library. The following forms may be downloaded instantly upon purchase, in .doc format, ready for you to add your practice information, edit as you wish, and USE! PDF and JPG formats available upon request.

HIPAA Documents for Internal Use

Staff Confidentiality Agreement

Record of Chart Movement

Fax Cover Sheet

Email Notice

Business Associate Confidentiality Agreement

Privacy Policies Training Acknowledgement

HIPPAA Documents for Use With Clients/Patients

Restriction of Use and Disclosures Request Form

Notice of Privacy Practices, short summary

Notice of Privacy Practices, detailed form

Medical Release, two way

Medical Records release to midwife

Disclosure of Protected Health Information

Consent and Release of Information or Images

Confidential Health Information

Conditions of Service

Birth Center Notice of Privacy Practices

Amendment of Health Record Request Form

Acknowledgement of Receipt of Privacy Policy, long form

Acknowledgement of Receipt of Notice of Privacy Practices, simple form

Accounting of Disclosures Request form

For instructions on how to use these forms, and how to be in compliance with new HIPAA standards, we recommend you take Maryl Smith's course that is a companion to these documents: A Heappa HIPAA Help...and Heroic Updates. 

If you wish to purchase both the course and the forms, you may do so together for $20 off by selecting the HIPAA Heroes Bundle at the very bottom of this page.

Cartoon by R.J. Romero and used with permission.

  • Forms Created By:

    Instructor Bio:

    Maryl Smith, CPM, LDM, has an active homebirth practice and has been catching babies since 1984. Over the years she has cared for women from over 18 different nations, worked in two free-standing birth centers, taught as adjunct staff at Birthingway College of Midwifery and served in multiple roles in the promotion of midwifery in the state of Oregon. Her passion is supporting trauma survivors during the perinatal experience. Maryl frequently travels the world with her pastor/musician husband working to preserve indigenous spiritual expression in music. Her other activities include adventures with her granddaughters, herb gardening, writing and being active in her local Native American community.

    Maryl Smith

    CPM, LDM

Downloadable Forms

Ready to be customized for your practice

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    HIPAA Documents - .doc version
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    • HIPAA Documents for Internal Use
    • HIPAA Documents to Use With Clients

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  • By Betty Ludlow

    “Maryl did a great job and the handouts were a blessing!”

    “Maryl did a great job and the handouts were a blessing!”

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