KANSAS

                                                                       ______________________                                                                   

WILLIAM R. SECK, SUPERINTENDENT                                                                           KATHLEEN SEBELIUS, GOVERNOR

KANSAS HIGHWAY PATROL

 

HIPAA DOCUMENTATION FOR

LAW ENFORCEMENT PURPOSES

 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows medical providers to cooperate with law enforcement in the investigation of crimes and protection of victims.   45 C.F.R. §164.512(f)(1)-(6)  Pursuant to that authorization, this is an investigatory demand for information regarding _______________________________________ (Name, DOB or description).

 

1.  This person has consented to the blood test requested pursuant to K.S.A. 8-1001.

 

       ___________________________________________________   __________

       Signature of Consent                                                  DATE

 

2.  This person is unconscious or dead.  As such, consent for the test is created through K.S.A. 8-1001(a).

 

       ___________________________________________________   __________

       Signature of Officer                                                    DATE

 

The officer, being of lawful age and upon my oath does solemnly state as follows:

 

  1. The information sought is relevant and material to a legitimate law enforcement inquiry.
  2. This is a specific request limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought.

a. The specific request for information is as follows:

 

 

 

 

  1. De-identified information cannot reasonably be used.

 

          ________________________________________             ________________

          Officer signature, Radio Number                                   Date

 

This documentation may be provided to the person regarding whom information is sought in compliance with HIPAA.  45 CFR §164.501

 

If you have any questions, please contact the Kansas Highway Patrol Legal Office at (785) 296-6800.