HORRY COUNTY HIPAA COMPLIANCE SURVEY

MANY HORRY COUNTY EMPLOYEES MAY SEE, HEAR, SHARE OR HAVE ACCESS TO PERSONAL HEALTH INFORMATION IN THE COURSE OF THEIR JOB DUTIES. IN THIS HIPAA SURVEY, WE ARE ADDRESSING YOUR POTENTIAL CONTACT WITH PERSONAL HEALTH INFORMATION AS PART OF YOUR JOB.
PERSONAL HEALTH INFORMATION INCLUDES ANY AND ALL INFORMATION ABOUT A PERSON THAT NOT ONLY REFERS TO THEIR MENTAL OR PHYSICAL CONDITION, BUT INFORMATION THAT INDENTIFIES A PERSON’S HEALTH INSURANCE STATUS, AND WHETHER THEY ARE ELIGIBLE OR ENROLLED IN A PARTICULAR PLAN. PERSONAL HEALTH INFORMATION INCLUDES ALL FORMS OF ELECTRONIC, WRITTEN AND EVEN VERBAL INFORMATION ABOUT HEALTH CARE OR INSURANCE STATUS OF AN INDIVIDUAL.
Name: 


A red asterisk (*) indicates required questions.

  1. Job Title:*


  1. Department:*


  1. Employee Number:*


  1. HERE ARE EXAMPLES OF PHI THAT YOU MAY ENCOUNTER IN YOUR JOB:(CHECK ALL THAT APPLY)*
    Authorizations and referrals
    Background checks
    Birth and death certificates
    Behavior rating scales
    Cancer registry listings
    Case management files or notes
    Chemical health treatment notes
    Claims and claim attachments
    Collections for medical services
    Diagnosis or treatment plans
    Enrollment or disenrollment info
    Pathology reports
    Health plan records
    Discharge summary
    Doctor’s orders or notes
    Insurance eligibility information
    Immunization records
    Lab tests and data
    Medical and dental charts
    Therapy or treatment plans


  1. PLEASE IDENTIFY ALL ACTIVITIES THAT YOU PERFORM THAT MAY CAUSE YOU TO SEE, HEAR, OR HAVE ACCESS TO PHI (CHECK ALL THAT APPLY)*
    Claim or Records
    Data analysis or reporting
    Coordination of benefits
    Data entry
    Eligibility inquiry, determinations
    Enrollment or disenrollment
    Filing, filming, scanning or copying PHI
    Health services billing
    Health services collection
    Handling of PHI in mail or faxes
    Intake of PHI
    Provide medical treatment
    Quality management
    Provide therapy or treatment sessions
    Medical treatment planning or review


  1. PLEASE INDICATE HOW OFTEN YOU SEE, HEAR, DISCUSS OR HAVE ACCES TO PHI IN YOUR JOB BY CHOOSING THE MOST APPROPRIATE RESPONSE BELOW:*
    On a daily basis as part of my job duties
    Sometimes, but not on a daily basis
    Occasionally
    Rarely
    Never


  1. I HAVE ACCESS TO PHI THROUGH CONTACT WITH (CHECK ALL THAT APPLY):*
    Agencies that analyze our data
    Billing or payment agencies
    Computer Database
    Collection agencies
    Patients or their representatives
    Compliance agencies
    Contractors or Business Associates
    Coroner’s reports
    Health Care providers
    Insurance companies
    State of South Carolina Health Plan
    Law enforcement or the courts
    Other Counties
    Other departments in Horry County
    Oversight agencies
    Within my own department
    None
    Other


  1. IF YOU ANSWERED "OTHER" IN THE PREVIOUS QUESTION, PLEASE EXPLAIN:


  1. WHAT ARE ALL THE WAYS YOU COME INTO CONTACT WITH PHI AT WORK? (CHECK ALL THAT APPLY)*
    I have access to databases, computers or other electronic files containing PHI
    I view or have access to reports or other paperwork that contain PHI
    I view or have access to PHI about program or benefit eligibility
    I have access to files about clients, patients, or employees and their PHI
    I make or receive phone calls concerning PHI or health care eligibility
    I receive or have access to faxes that may contain PHI
    I receive or have access to emails that may contain PHI
    I hear conversations or talk with others about PHI as part of my job
    I never see, hear, discuss or have access to PHI


  1. PLEASE IDENTIFY ALL INDIVIDUALS, ORGANIZATIONS OR DEPARTMENTS WITH WHOM YOU REVIEW, SEND, TRANSMIT, RECEIVE, DISCUSS OR IN ANY WAY SHARE PHI ABOUT PATIENTS, CLIENTS OR EMPLOYEES. (CHECK ALL THAT APPLY)*
    Contractors
    Coroners
    Courts
    Family members of citizens, patients or individuals
    Federal agencies
    Health care providers
    Individuals or their representatives
    Insurance companies
    Other counties
    State agencies
    Other Horry County departments


  1. IF YOU ANSWERED "OTHER HORRY COUNTY DEPARTMENTS" IN THE PREVIOUS QUESTION, PLEASE EXPLAIN:


  1. ARE YOU AWARE OF POLICIES OR PROCEDURES IN PLACE THAT ADDRESS THE HANDLING OF PHI OR PERSONAL HEALTH INFORMATION?*
    Yes
    No
    I don’t know


  1. IF YOU ANSWERED YES, ARE THE POLICIES OR PROCEDURES IN WRITING?*
    Yes
    No


  1. DO YOU HAVE ANY CONCERNS ABOUT HOW PHI IS HANDLED BY HORRY COUNTY EMPLOYEES? *
    Yes
    No




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