Signature: I have the authority to bind the Organization. Name (Printed): Title: Date (“Effective Date”): Appendix Electronic Health Record Policies Applicable to the Annual Privacy and Security – Operational Self-Attestation for <year> Access and Correction Policy v1.0 – Assurance Policy v1.0 – Consent Management Policy v1.0 – Inquiries and Complaints Policy v1.0 – Logging and Auditing Policy v1.0 – Privacy and Security Training Policy v1.0 – Privacy Breach Management Policy v1.0 – Information Security Policy v2.3 – Acceptable Use of Information and Information Technology v1.4 – Access Control and Identity Management Policy for System Level Access v1.3 – Local Registration Authority Practices v1.3 – Identity Federation Standard v1.3 – Business Continuity Policy v1.2 – Cryptography Policy v1.3 – Electronic Service Providers Policy v1.3 – Information Security Incident Management Policy v1.3 – Information and Management Policy v1.3 – Network and Operations Policy v1.3 – Security Logging and Monitoring Policy v1.5 – Systems Development Lifecycle Policy v1.4 – Physical Security Policy v1.3 – Threat Risk Management Policy v.1.3 –
Signature: Name (Printed): I have the authority to bind the Organization. Title: Date (“Effective Date”): Appendix – Electronic Health Record Policies Applicable to the Annual Privacy and Security Operational Self-Attestation for <year> Access and Correction Policy – v1.0 Assurance Policy – v1.0 Consent Management Policy – v1.0 Inquiries and Complaints Policy – v1.0 Logging and Auditing Policy – v1.0 Privacy and Security Training Policy – v1.0 Privacy Breach Management Policy – v1.0 Information Security Policy – v2.3 Acceptable Use of Information and Information Technology – v1.4 Access Control and Identity Management Policy for System Level Access – v1.3 Local Registration Authority Practices – v1.3 Identity Federation Standard – v1.3 Business Continuity Policy – v1.2 Cryptography Policy – v1.3 Electronic Service Providers Policy – v1.3 Information Security Incident Management Policy – v1.3 Information and Management Policy – v1.3 Network and Operations Policy – v1.3 Security Logging and Monitoring Policy – v1.5 Systems Development Lifecycle Policy – v1.4 Physical Security Policy – v1.3 Threat Risk Management Policy – v.1.3
07_SAMPLE_EHR_Self-Attestation_Letter.docx