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OASIS Privacy Notices - Statement of Patient Privacy Rights/Privacy Act

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$28.80

Updated 2025

Provide home health agency patients with written notice of their privacy rights related to OASIS data collection.

Privacy Act Statement - Health Care Records is printed on the back.

Download a sample today!


As required by the HH Conditions of Participation (COP), an OASIS privacy notice must be provided to all patients for whom the OASIS data is collected. Due to the transition to OASIS data collection for all patients, regardless of payer, effective January 1, 2025 Home Health Agencies should only provide patients with the CMS Privacy Act Statement and Attachment A - Statement of Patient Privacy Rights.

Beginning January 1, 2025 and until further notice, Attachment C – Notice About Privacy for Patients Who Don’t Have Medicare or Medicaidshould not be provided to patients.

Size: 8 1/2" x 11"

Paper: white paper

Print: black ink, printed two sides different

Packaging: 100 per pad

No hole punching on this form

Updated 2025

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