I understand that under the Health Insurance Portability & Accountability Act of 1996 ("HIPAA"), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:
1. Conduct, plan and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
2. Obtain payment from third-party payers.
3. Conduct normal healthcare operations such as quality assessments and physician certifications.
I have received, read and understand your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.
PERMISSION TO DISCUSS DENTAL TREATMENT
In the event that you may want a family member or friend to discuss your dental treatment with our office, we must have in writing permission/consent from you to do so. Please list any person you give Mckinneydentist.com permission/consent to discuss your dental treatment with. ** If the patient is a minor, we will discuss dental treatment with either parent or guardian**