Notification of CVI Access or Disclosure Emergency or Exigent Circumstances Instrument Scope

Notification of Emergency or Exigent Circumstances Instrument

Name of Instrument

Notification of Emergency or Exigent Circumstances

Scope of Instrument

This instrument collects:

• Personally identifiable information from the individual reporting the exigent circumstance

• Relevant facility information

• Relevant details about the emergency or exigent circumstance

Example of DHS Forms used within the scope of this instrument

Attached is DHS Form 9024 that is used to standardize the collection of information within this instrument. DHS Form 9024 identifies most, but not all of the data routinely collected under this instrument.

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