H125 – Notice of Privacy Practices

Responsible Office: Institutional Compliance Office

Last Review: 04/01/2021

Next Review: 04/01/2024

Contact: Melanie Burlison, Privacy Officer

Phone: 901.448.8030

Email: institutional.compliance@uthsc.edu

Related Policies: FI0160 – HIPAA Re-designation and General Policy


To ensure each patient of UTHSC receives a Notice of Privacy Practices (NPP) and has the opportunity to discuss the notice with his or her provider and acknowledges receipt of the notice of privacy practices.


The Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires each patient is provided with a Notice of Privacy Practices (NPP), to the health care organization’s patients. The goal of the NPP is to inform patients:

  1. How the health care organization will use and disclosure a patient’s PHI;
  2. The patient’s rights and responsibilities with respect to his/her PHI; and
  3. The covered entity’s duties with respect to a patient’s PHI.

This procedure describes how UTHSC NPP (H126 UTHSC – Notice of Privacy Practices) is provided to our patients and acknowledged.


Protected Health Information (PHI) – information about a patient, including demographic information that may identify a patient that relates to the patient’s past, present or future physical or mental health or condition, related health care services or payment for health care services.


  • When medical or dental records are prepared for clinical appointments, the medical or dental record is verified to ensure there is a signed acknowledgement of receipt of the Notice of Privacy Practices.
  • If there is not a signed acknowledgement, a blank acknowledgement and NPP is attached to the medical or dental record for the patient to complete at registration. If the NPP is in electronic format, the patient should be given access to a computer for completion of the form in the patient portal. When the patient signs the acknowledgement, it is filed in the medical or dental record.
  • Each clinical site must determine what type of tracking system will be utilized to track the signed acknowledgment forms. Some clinical sites have computerized tracking of the acknowledgement. Please add this as it applies to your site.

H125 – Notice of Privacy Practices
Version: 1 // Effective: 04/01/2021
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Related Policies: