Our Federal HIPAA Privacy Notice provides information about how we may use and disclose protected health information about you. The patient rights section describes your entitlements under the law. You have the right to review our Notice before signing a consent. You have the right to revoke your consent in writing. However, such a revocation shall not affect any disclosures we have already made based on your prior consent. Our practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Notice. As our patient, you are acknowledging that:
- Protected health information may be disclosed for treatment, payment or healthcare operations per our Federal HIPAA Privacy Notice, which you have the opportunity to review.
- The patient can ask to restrict uses of their information, but we are obliged solely to comply within the parameters of the law.
- The patient may revoke this consent in writing at any time, and all future disclosures will then
- The practice may, at their discretion, condition treatment upon execution of this
The practice reserves the right to change the notice based on amendments to federal law.