This document certifies that Monique A. Tackitt completed HIPAA privacy and security training on July 12, 2014. It acknowledges she reviewed training materials on HIPAA privacy and information security awareness as required for all health care providers and staff. Her supervisor should retain this certificate with her personnel training records as proof the training requirement was met.

1. Health Administration Corporate Compliance /
Privacy & Security Professional Program
PCDI | Affiliated with HIPAAtraining.com
5114 Balcones Woods Dr
Suite 307, #331
Austin, TX 78759
Tel: (512) 402-5963
Acknowledgment of HIPAA Privacy &
Security Training
Instructions:
All health care providers, staff, students, health professional trainees, volunteers and
other workforce members are required to complete HIPAA privacy and security training
at the time of hire or appointment. To demonstrate that the training requirement was met,
this "Acknowledgment of HIPAA Training" form is hereby issued for, HIPAA Training
– HP101. Supervisor: Retain this certificate with personnel training records.
Training Material(s) Reviewed:
CERTIFICATE OF COMPLETION
HIPAA Privacy and Information Security Awareness Training was completed by:
Last Name First Name M.I.
TACKITT MONIQUE A.
Date of Training
JULY 12, 2014
Representative Signature
Joss Bascom