HIPAA Forms
Introduction
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Insurance

 

In regards to recent changes, the Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed to us in any form, whether electronically, on paper, or orally, to be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by law, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

For printing and viewing purposes, we have provided the following files for download prior to arriving in our offices.

Type File Size Description
Notice of Privacy Practices 90.0 kb Notice of Privacy Practices
Acknowledgement of Privacy Rights 86.3 kb Acknowledgement of Privacy Rights
Patient Authorization 39.9 kb Patient Authorization Form

*Download free Adobe Acrobat Reader for viewing and printing .pdf files