We care about our patients' privacy and strive to protect the confidentiality of your medical information at this practice. New Federal legislation requires that we issue this official notice to our privacy practices. You have the right to the confidentiality of your medical information, and this practice is required by law to maintain the privacy of that protected health information.
I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission.
The HIPAA Privacy Rule for the first time creates national standards to protect individuals’ medical records and other personal health information:
It gives patients more control over their health information.
It sets boundaries on the use and release of health records.
It establishes appropriate safeguards that health care providers and others must achieve to protect the privacy of health information.
It holds violators accountable, with civil and criminal penalties that can be imposed if they violate patients’ privacy rights.
And it strikes a balance when public responsibility supports disclosure of some forms of data – for example, to protect public health.
For patients – it means being able to make informed choices when seeking care and reimbursement for care based on how personal health information may be used.
It enables patients to find out how their information may be used, and about certain disclosures of their information that have been made.
It generally limits release of information to the minimum reasonably needed for the purpose of the disclosure.
It generally gives patients the right to examine and obtain a copy of their own health records and request corrections.
It empowers individuals to control certain uses and disclosures of their health information.
Additional information can be found at US Dept of Health & Human Services website: