The following acknowledges the fact that our office is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). There will be a form in our office that you will sign to verify that you have reviewed the following facts:
- Protected health information may be disclosed or used for treatment, payment, or healthcare operations.
- The practice has a Notice of Privacy Practices and the patient will have the opportunity to review this notice. This is available upon request by any patient.
- The practice reserves the right to change the Notice of Privacy Practices.
- The patient has the right to restrict the use of their health information, but the practice does not have to agree to these restrictions.
- The patient may revoke this consent in writing at any time and all future disclosures will then cease.
- The practice may condition treatment upon the execution of this consent.