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Information Flow Assessment Questionnaire 10 <br /> SOURCES I Semi Receive Paper Electronic Fax Phone <br /> Private Practice <br /> Attorney <br /> Audiologist <br /> Chiropractor <br /> Dentist <br /> HMO/PPO <br /> Physician <br /> Private Allied Health Specialist <br /> Social Worker, Nutritionists <br /> Ps eholo ist <br /> Thera isf Occu „Speech,Ph I, Psych.) <br /> Other S eci <br /> Law Enforcement <br /> Attorney General's Office <br /> Clerk of Court <br /> Court <br /> District Attorney <br /> Law Enforcement Officer/Sheriff/Police <br /> Local Jail/Detention Center <br /> Parole Officer/Probation Officer <br /> Prison(Correctional Facility <br /> Other S ecif <br /> Financial <br /> Auditor <br /> Bank <br /> Billing/Collection Service <br /> Court <br /> Estate <br /> Payer/insurance Company <br /> Other S cl <br /> Additional <br /> Clearing house <br /> Client <br /> Contractor <br /> Coroner <br /> Dept./Div/Office Public Information Officer <br /> Employees <br /> Employers <br /> Family/Guardian <br /> Friend/Neighbor <br /> Funeral Homes <br /> Guardian Ad Litem <br /> Health Plan <br /> Legislatc,r State&Federal <br /> Media Radio,N,Newspaper,Web,etc. <br /> Other State Agencies <br /> Out-of-State Aqencies <br /> Researchers or Research Facility <br /> ReviewlOversi hl Boards/Committees <br /> Trans ort(Ambuhance.Providers <br /> Vendor <br /> Other(Specify <br /> COMMENTSIADDITIONAL INFORMATION: <br /> July mst-venuan 4 HIPAA 12 <br />