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Inland Regional Center

info@inlandrc.org

1365 S. Waterman Ave., San Bernardino, CA, 92408, US

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Regional Center
Developmental Center Community Facility
DDS
Initial Incident Report
Addendum to Previous Report
500 or more individuals
Fewer than 500 individuals affected by the breach
Hacking IT Incident
Desktop Computer
Improper Disposal
Loss
Theft
Unauthorized Access Disclosure
YES_1
NO_1
ElectronicMedical Record
YES_2
NO_2
E Mail
YES_3
NO_3
Laptop
YES_4
NO_4
Network Server
YES_5
NO_5
Other Portable Electronic Device
YES_6
NO_6
Paper Films
Other
YES
NO
Name
Account number credit or debit card number in
Address Zip
Date of Birth
Driver s License State ID Number
Social Security Number
User name or e mail address in combination
Medications
Lab Results
NO
Other Financial Information
Health Insurance Information_1
OtherMedical Information_1
Other Specify_2
YES
NO_4
Privacy Rule Safeguards
Breach Security Rule Administrative Safeguards
Security Rule Physical Safeguards access controls workstation security etc
Security Rule Technical Safeguards access controls transmission security etc
NO_1
NO_2
Changed password strengthened password requirements
Create a new updated Security Rule RiskManagement Plan
Implemented new technical safeguards
NO_3
Improved physical security
Performed a new updated Security Rule Risk Analysis
Provided business associated with additional training on HIPAA requirements
Provided individuals with free credit monitoring
Revised business associate contracts
Revised policies and procedures
Sanctioned workforce members involved including termination
Took steps to mitigate harm
Trained or retrained workforce members
Other
x

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