POLICIES

The Health Insurance Portability and Accountability Act of 1996  (HIPAA), established a Privacy Rule to help ensure that personal health care information is protected for privacy. The Privacy Rule was also created to provide a standard for certain healthcare providers to obtain their patients’ consent for the use and disclosure of health information about the patient to carry out treatment, payment, or healthcare operations.

The Health Insurance Portability and Accountability Act of 1996  (HIPAA), established a Privacy Rule to help ensure that personal health care information is protected for privacy. The Privacy Rule was also created to provide a standard for certain healthcare providers to obtain their patients' consent for the use and disclosure of health information about the patient to carry out treatment, payment, or healthcare operations.

We fully support your access to your medical records. We  may have indirect treatment relationships with you (such as  laboratories that only interact with the physician and not patients),  and may have to disclose personal health information for purposes of  treatment, payment or health care operations. These entities are most  often not required to obtain patient consent.

You may refuse to consent to the use or disclosure of your personal  health information, but this must be done in writing. Under this law,  we have the right to refuse to treat you should you choose to refuse to disclose your Personal Health Information. If you choose to give  consent in this document, at some future time you may request to  refuse all or part of your Personal Health Information. You may not revoke actions that have already been taken which relied on this or a  previously signed consent.

If you have any objections to this form, please ask to speak with our  HIPAA Compliance Officer. You have the right to review our Privacy  Notice (Compliance Assurance Notification to Our Patients), to  request restrictions and revoke consent in writing.