HIPAA Security Policy Acknowledgment Form
 
NORTH DAKOTA DEPARTMENT OF HEALTH

After reading all of the HIPAA security policies, please complete the acknowledgment form below and press the submit button to send it to the HIPAA team for proper documentation. 

If you have any questions about these HIPAA policies, please type them in on the acknowledgment form or contact the HIPAA team directly:

Privacy - Darleen Bartz or Bridget Weidner (328-2352)

Security/Transactions - Darin Meschke (328-2494)

Thank you.

 

SECURITY POLICY ACKNOWLEDGMENT FORM

(MM/DD/YYYY)