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HIPAA Risk Assessment Checklist Template

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HIPAA Risk Assessment Checklist Template

General Information

Describe the scope of this HIPAA Risk Assessment

List all participants including role (e.g. physician, resident, nurse, med tech, network manager, etc.)

Describe key technology components including commercial software

Describe how users access the system and their intended use of the system

Risk Assessment

Click (+) Vulnerability after you have identified a vulnerability or threat source

Threat Source & Vulnerability

Observation

Threat source/ vulnerability

Evidence (flow diagrams, screenshots etc.) (optional)

Existing controls

Risk Rating

Consequence

Likelihood

Risk rating

Recommended Controls

Recommended controls or alternative options for reducing risk

Confirmation

Recommendations

Full Name

Signature

Date

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