HIPAA PRIVACY RELEASE FOR NOTEBOOK IN A BACKPACK

 

I understand that the notebook in my child’s backpack/cubby contains health information protected under federal privacy laws (HIPAA), including notes back and forth between me, my therapists, and my child’s teachers. I agree to allow my child to keep this notebook in his/her backpack and transport it back and forth to school. Please visit our website at www.earlybirdonline.com to read our Notice of Privacy Practices. For a paper copy of the notice, please contact Bob Kornfeld at 704-995-2929 or bob@earlybirdonline.com.

 

I also understand that I can revoke this authorization at any time by emaiing Bob at bob@earlybirdonline.com