Our office is required by law to maintain the privacy of your Protected Health Information (PHI). We are also required to give you notice about our privacy practices, our legal duties, and your rights concerning your protected health information.
I understand that under the Health Insurance Portability and Account Act of 1996 (HIPAA), I have certain rights to privacy regarding my Protected Health Information (PHI).
I understand that my information can and will be used to:
- Conduct, plan, and direct my treatment and follow up among the multiple health care providers, who may be involved in the treatment directly or indirectly
- Obtain payment(s) from third party payers
- Conduct normal healthcare operations
- To communicate with you or persons involved in care
- You have a right to obtain access to your health information and request copies.
- You have the right to request a restriction on the use or disclosure of your health information.
- You have the right to request to receive communications by alternative means or at alternative locations.
- You have the right to request an amendment to your health information.
- You have the right to receive and accounting of certain disclosures we have made, in any, of your protected health information.
Electronic Notice: You may receive a paper copy of this notice upon request, even if you have agreed to receive this notice electronically.