Resource: Privacy, Risk, and Discipline Assessment

By Jennifer McAleer and Ryan Stanberry


RISK ASSESSMENT
Breach Risk Assessment	HIPAA (45 CFR 164.530)		WA RCW 42.19.255/HB 1071		Case #:
	Definitions		Definitions
	Exclusions		Exclusions
	Breach		Breach		Case Name:
	Notification		Notification
	Time Frame		Time Frame
	Exceptions		Exceptions
Description	Choose Best Option	Score	Choose Best Option	Score	Comments
Is Section Applicable?	Applicable	TRUE	Applicable	TRUE
Content: Nature & Sensitivity of Info	Content	FALSE	Content	FALSE
Person: Who was info disclosed to?	Person	FALSE	Person	FALSE
Access: Was the info acquired or viewed?	Access	FALSE	Access	FALSE
Mitigation: Has risk been mitigated?	Mitigation	FALSE	Mitigation	FALSE
Calculation: Content + Person + Access - Mitigations = Risk Level	SUBMIT REPORT? -2 THROUGH 1: Lowest Risk, No Report 2 THROUGH 5: Low Risk, No Report 6 THROUGH 9: Moderate Risk, Consider Reporting (depending on LoProCo) 10 THROUGH 14: Highest Risk, Consider Reporting (depending on LoProCo)	0	SUBMIT REPORT? -2 THROUGH 1: Lowest Risk, No Report 2 THROUGH 5: Low Risk, No Report 6 THROUGH 9: Moderate Risk, Consider Reporting (depending on LoProCo) 10 THROUGH 14: Highest Risk, Consider Reporting (depending on LoProCo)	0
BREACH EXCEPTIONS
Description of Exceptions	Not Applicable		Not Applicable
LO PRO CO ANALYSIS
Low Probability of Compromise?
BREACH NOTIFICATION
Breach Notification?
Notification Date Calculation
Accounting of Disclosures?
Other Reporting Requirements
SUMMARY OF INCIDENT

PERSON COMPLETING ASSESSMENT
Name:
Title:
Date:

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