HIPAA - Sample Media Notification Statement/Release

___________________________ notified [Insert Number] patients of a breach of unsecured personal patient protected health information after discovering the following event:

(Describe event as follows)

1.  A brief description of what happened, including the date of the breach and the date of the discovery of the breach, if known.

2.  A description of the types of unsecured protected health information that were involved in the breach (such as whether full name, Social Security number, date of birth, home address, account number, diagnosis, disability code or other types of information were involved).

3.  Any steps the individual should take to protect themselves from potential harm resulting from the breach.

4.  A brief description of what the organization is doing to investigate the breach, to mitigate harm to individuals, and to protect against further breaches.

5.  Contact procedures for individuals to ask questions or learn additional information, which includes a toll-free telephone number, an e-mail address, Web site, or postal address.

As a result of this breach, steps are underway to further improve the security of its operations and eliminate future risk.

In a notification to patients, ____________________________ has offered their resources as and has encouraged its patients to contact their financial institutions to prevent unauthorized access to personal accounts.

_____________________________________ understands the importance of safeguarding our patients’ personal information and takes that responsibility very seriously,” sai?  ____________________________.  “We will do all we can to work with our patients whose personal information may have been compromised and help them work through the process.  We regret that this incident has occurred, and we are committed to prevent future such occurrences.  We appreciate our patients support during this time.”

Please direct all questions to _________________________.