ROWAN UNIVERSITY POLICY
Title: Identity Theft Prevention Program-Red Flag Rules
Subject: Corporate Compliance and Privacy
Policy No: CCP: 2017: 01
Applies: Rowan School of Osteopathic Medicine
Issuing Authority: Dean, RowanSOM
Responsible Officer: Chief Audit, Compliance & Privacy Officer
Adopted: 03/20/2017
Last Revision: 03/20/2017
Last Reviewed: 03/20/2017
I. PURPOSE
The purpose of this policy is to ensure that the RowanSOM complies with the Federal Trade Commission’s (FTC) Identity Theft Rules under sections 114 and 315 of the Fair and Accurate Credit Transactions Act (FACT Act). These regulations are also known as the Red Flags Rule. Under this policy, RowanSOM shall design a program to detect, prevent and mitigate identity theft in connection with the opening of a covered account or any existing covered account. This program shall mitigate the risks associated with identity theft and mitigate the effects of identity theft on RowanSOM, its employees, its students, its patients, its constituents and its customers. This policy also addresses the administration of Perkins Loans, Institutional Loans and the provision of an extended tuition payment plan.
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This form should be completed by the hospital or other facility personnel when the identity of a patient is questioned, either because of identity theft or patient misidentification.
Form completed by: ______________________________________
Date/Time: ______________________________________
Title: ______________________________________
Department: ______________________________________
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Patient presented to facility using the following information:
Name: _______________________________________
Phone: _______________________________________
Address: __ _______________________________________
_______________________________________
SS#: _______________________________________
DOB: _______________________________________DOB:
Date/ Time: _______________________________________
Presenting Complaint:
_______________________________________
Date/ Time:
Presenting Complaint:
Existing MR # Used: ________________ New MR #: ___________________ I Created: ___________________________
Account No. Assigned: ___________________________________ Consent Form Signature: __________________________________
Insurance Information Presented (specify if Medicaid, Medicare, or other governmental programs):__________:_____________________
Was the health information of any other patient provided to this individual? Does the hospital/facility need to account for the disclosures.
Name of “other” patient: ________ ________________________________________________________________________________
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_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
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List all involved staff members: ____________________________________________________________________________________
Based on investigation, the correct patient is:
Name: ________________________________________________ Phone: _________________________________________________
Address:
SS#: ___________________________________DOB: ____________
Reason: __ _____________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________
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