Protected Health Information (PHI) Governance Assessment Form
Assess your organization’s PHI governance practices. This form does not collect sensitive health information.
Organization Name
*
How would you rate your organization’s overall PHI governance maturity?
*
1
2
3
4
5
Does your organization have documented PHI governance policies?
*
Yes, comprehensive and up-to-date
Yes, but needs updating
No, but in development
No policies in place
How frequently does your organization conduct PHI governance training for staff?
*
Annually or more often
Every 2-3 years
Rarely
Never
Who is primarily responsible for PHI governance in your organization?
*
Please Select
Chief Privacy Officer
Compliance/Legal Team
IT/Data Security Team
Department Managers
No designated person/team
Please indicate your level of agreement with the following statements regarding PHI governance:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Staff are aware of PHI governance policies
1
2
3
4
5
PHI access is regularly reviewed
6
7
8
9
10
There are clear procedures for reporting PHI breaches
11
12
13
14
15
How does your organization monitor compliance with PHI governance policies?
*
Internal audits
External audits
Automated monitoring tools
Manual review
No monitoring in place
Other
In the past 12 months, how many PHI-related incidents or breaches have been reported?
*
None
1-2
3-5
More than 5
Unknown
How confident are you in your organization's ability to respond effectively to a PHI breach?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
What is the top area for improvement in your PHI governance program?
*
Please Select
Policy updates
Staff training
Incident response
Access controls
Monitoring/auditing
Other
Submit Assessment
Should be Empty: