Attestation of No Protected Health Information
Please provide a separate Protected Health Information Form for each content provider (author) and speaker.
It is my responsibility, as the presenter, to ensure that no protected health information (PHI) is included in this presentation.
Under the Health Insurance Portability and Accountability Act (HIPAA), PHI is any information that is related to an individual’s health condition or the provision of or payment for health care to an individual and that could be used to identify the individual.
PHI includes:
- Account numbers
- Biometric identifiers such as fingerprints and voiceprints
- Certificate/license numbers
- All elements of dates (except year) directly related to an individual, including birth date, admission date, discharge date, and date of death
- All ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
- Device identifiers and serial numbers
- E-mail addresses
- Fax numbers
- Full-face photographic images
- Geographic identifiers smaller than a state
- Health plan beneficiary numbers
- Internet Protocol (IP) address numbers
- Medical record numbers
- Names
- Social Security numbers
- Telephone numbers
- Vehicle identifiers such as serial and license plate numbers
- Web universal resource locators (URLs)
- Any other unique identifying number, characteristic, or code
If you have any questions about Protected Health Information, contact the following Vizient officials:
Roya Evans, Compliance & Privacy Manager at (972) 830-8633 or roya.evans@vizientinc.com.
I attest that my presentation/abstract does not contain Protected Health Information (PHI)
Click the link below to download the PHI Attestation form and submit with your presentation.
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