This form is used to report potential unauthorized access, use, or disclosure of protected health information.
About This Offering
Features and Benefits
Report Potential Unauthorized Access, Use, or Disclosure of PHI – This form is used to report any suspected or confirmed incidents involving unauthorized access, use, or disclosure of Protected Health Information (PHI). If you believe PHI has been improperly handled, please provide as much detail as possible to help us investigate and address the issue appropriately.
Other Names
N/A
Provider
Office of Medicaid Innovation (OMI)
Using This Offering
Who can use this offering?
Everyone
How do I request this offering?
Click on the "Report Potential Data Breach" button on the right side of the page
Is there a charge to use this offering?
None
Where can I learn more?
N/A
Support
How do I get help?
Using this form is the preferred method for contacting the Office of Medicaid Innovation (OMI) IT Security Team.
When is support available?
University Business Hours