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Request Your Private AI Exposure Review

Complete the questionnaire below to help HIPAASafeAI understand your organization's current AI use and determine whether the fixed-scope review is a good fit.

Important Privacy Notice

Do not enter patient names, medical record numbers, treatment information, account credentials, or any other protected health information in this form. HIPAASafeAI does not need patient records to evaluate your organization's AI workflows.

Primary Contact
Organization
Does the organization handle protected health information?
Current AI Use
Which AI tools are currently used or believed to be used by employees?
How are these tools accessed?
How is AI currently being used?
Information and Risk
What types of information could potentially enter these AI workflows?
Has the organization experienced or suspected an accidental disclosure involving an AI tool?
Does the organization currently have a written AI acceptable-use policy?

List tool names or general restrictions only. Do not include sensitive information.

Review Goals
What would you most like to understand or accomplish?

Do not include patient information, credentials, or other sensitive information.

Required acknowledgments

Submitting this form does not obligate you to purchase the review. HIPAASafeAI will evaluate the request and contact you regarding fit, availability, and next steps.