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Policies & Forms

Policy No. Policy
HIP 06-004 (pdf) Employee Sanctions HIPAA Violations
HIP 06-008 (pdf) Accounting of Disclosures
HIP 06-009 (pdf) Enrollee Access to PHI
HIP 06-014 (pdf) De-identification of Enrollee Records
HIP 06-016 (pdf) Request to Amend Enrollee Records
HIP 06-017 (pdf) Complaints for HIPAA Violations
HIP 06-018 (pdf) Use of Enrollee Records in Research
HIP 06-025 (pdf) Enrollee Request to Restrict Access to PHI

 

Forms

English Espanol
Opt Out Request (pdf) Petición de rechazo
Permission to Release record (pdf) Permiso para divulgar Información Médica Amparada (IMA)
Request to Amend (pdf) Petición para enmendar expedientes médicos

Note: the below agreements are subject to change and users should contact TennCare for questions regarding revised versions.
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