To: Employee name
From: Supervisor name
Subject: Final Warning – HIPAA Violation
This letter is to serve as a final warning letter:
Recently, a situation was uncovered in which you displayed a serious lack of judgment and unprofessional behavior which is against University Policy and the Health Insurance Portability and Accountability Act (HIPAA). State details of violation, such as “on DATE, you faxed a patient record to the incorrect fax number, etc.”
The University of Miami Privacy Office reviewed this case and states that you have committed a breach due to your disregard for security related Privacy of Protected Health Information and have violated the University of Miami Policies and Procedures with respect to the security of Protected Health Information.
You must protect the privacy and confidentiality of patient information at all times and must adhere to all University policies. If you are unclear as to policies and procedures in the department, you are to immediately bring these issues to my attention. In addition, you must follow the instructions of your supervisor. Any future incidents including HIPAA related violations or performance problems will result in your termination.
I acknowledge by my signature below that I have been afforded the opportunity to review and sign this correspondence prior to it being placed in my personnel file.
Employee name Date
CC: Human Resources