HIPAA & Privacy

Two editable Word templates for a USA non-medical home care agency, in one instant download. Two client privacy forms for your intake packet: a Privacy Practices Letter and Privacy Consent Form, and a Notice of Privacy Practices Acknowledgment form.

Every file is an editable Microsoft Word (.docx) document. This is a Word-only download: no PDF, Excel, or Canva files are included. You can also open the files in Google Docs or LibreOffice; some layout may shift slightly.

What’s included (2 templates, 3 Word files in one ZIP)

1. Privacy Practices Letter and Privacy Consent Form (4 pages, Word)
2. Notice of Privacy Practices Acknowledgment (2 pages, Word)

Plus an Agency Instructions guide for the whole set. Remove it before use.

Who it’s for

• Home care agency owners setting up client privacy paperwork
• Intake staff who collect client signatures
• Agencies working with counsel on whether HIPAA applies
• Office managers organizing client privacy records

How it works

1. Purchase and instantly download one ZIP file with all the documents.
2. Open each file in Microsoft Word.
3. Use Replace All (Ctrl+H) to change [Agency Name] and [State] to your own details.
4. Fill in the blank lines with your own policies, contacts and choices, then save, print or share as needed.

Please note

• This is a digital download. No physical item will be shipped.
• This bundle does NOT include a Notice of Privacy Practices template. The Notice of Privacy Practices Acknowledgment is only the form a client signs to confirm they received your agency’s own Notice. If HIPAA applies to your agency, you will need a full Notice of Privacy Practices prepared or approved by your own counsel.
• These are customizable templates, not legal advice, and are not a license to operate or state-approved. They do not guarantee that your agency meets any law, licensing survey or standard.
• State rules vary. Check every state-specific item against your state requirements and have a qualified professional review the templates before use.
• Some lines cross-reference policy numbers from a companion Policy & Procedure Manual (sold separately); edit them to match your own policies.