The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy. Implementation of HIPPA requirements officially began on April 14, 2013. Many of the policies have been our practice for years. This form is a “friendly” version. A more complete text is posted in the office lobby.
What is this all about?
There are rules and restrictions on who may see or be notified of your Protected Health Information.
(PHI). These restrictions do not include the normal interchange of information necessary to provide you
with office services. HIPAA provides certain rights and protections to you as a patient. We balance
these needs with our goal of providing quality professional service and care. Additional
information is available from the U.S. Department of Health and Human Services. www.hhs.gov
We have adopted the following policies:
Patient information will be kept confidential except as necessary to provide a service or to ensure that all administrative matters related to your care are handled appropriately. This specifically includes sharing information with other healthcare providers, laboratories, and health insurance payers as necessary and appropriate.
It is the policy of this office to remind patients of their appointments. We may do this by telephone, e-mail, U.S. mail, or by any means convenient for the practice and/or as you requested. We may send you other communications informing you of changes to office policy and new technology that you might find valuable or informative.
The practice utilizes several vendors to conduct business. These vendors may have access to PHI but must agree to abide by HIPAA's confidentiality rules.
You understand and agree to government agencies or insurance payers inspecting the office and reviewing documents that may include PHI in the normal performance of their duties.
You agree to bring any concerns or complaints regarding privacy to the attention of the practice manager or doctor.
Your confidential information will not be used for marketing or advertising products, goods, or services.
We agree to provide patients with access to their records under the state and federal laws.
We may change, add, delete or modify any of these provisions to better serve the needs of both the practice and the patient.
You have the right to request restrictions in using your protected health information and to request changes in specific policies used within the office concerning your PHI. However, we cannot alter internal policies to conform to your request.
By signing below, I do hereby consent and acknowledge my agreement to the terms outlined in the HIPAA INFORMATION AND CONSENT FORM and any subsequent changes in office policy. I understand that this consent shall remain in force from this time forward.
