The privacy of your medical information, as described in the HIPPA Privacy Act, is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us at the address provided at the end of this notice. We may share medical information about you to doctors & other health care providers to assist them in treating you only with your written permission. We may include your medical information on a superbill provided to you to submit to your insurance company for payment purposes. 

Woman Wise Integrative Gynecology, LLC

I consent to outpatient gynecologic care and treatment by Katherine O’Brien MS, CNM at Woman Wise Integrative Gynecology, LLC.   I understand she has a masters degree as an Advanced Practice Nurse. Her area of focus is Midwifery, which at Woman Wise Integrative Gynecology, LLC will only include gynecologic services.  She will not provide prenatal, delivery, or postpartum care.  She is not a medical doctor and will let me know when something is beyond her level of expertise and I need to seek care elsewhere.  I understand that I am advised to maintain a relationship with a primary care provider, who is not Katherine O'Brien MS, CNM, for my general health care.  I understand that Katherine O'Brien MS, CNM does not provide emergency care or treat any type of breast or gynecologic cancer.  I will be referred to a cancer specialist for that.

I am aware that gynecology and lifestyle medicine approaches to common gynecologic problems are not an exact science and that no guarantees have been made regarding the results of treatment.  I agree to participate in an active manner, monitor my progress, and report any concerns to Katherine O'Brien MS, CNM. I also understand that any significant symptoms should be reported to my doctor.