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HIPAA Notice


  • Notice of Privacy Practices Acknowledgement
    • I understand that under the Health Insurance Portability & Accountability Act of 1996

      (HIPAA), I have certain rights to privacy regarding my protected health information (PHI). I understand that this information can and will be used to:

      Conduct, plan, and direct my treatment and follow-up among the multiple healthcare providers who may be involved in my treatment directly and indirectly.

      Obtain payment from third-party payers.

      Conduct normal healthcare operations such as quality assessments and physician certifications.

      I recieved read and understand your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my PHI. I understand that this organization has the right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time to obtain a current copy of the Notice of Privacy Practices.