|
|
|
Associates in Women’s Health 781
Colonial Drive Baton
Rouge, Louisiana Acknowledgement of Notice of Privacy Practices I
understand that, under the Health Insurance Portability & Accountability Act
of 1996 (HIPAA), I have certain rights to privacy regarding my protected health
information. I understand that this information can and will be used and
disclosed to:
· evaluate my health, diagnose my medical
condition, and provide treatment.
· obtain payment from third party payors
·
conduct normal operations of our medical practice, such as quality assessments,
physician
certifications,
appointment and surgery scheduling, etc.
·
fulfill other purposes which are listed in our Notice of Privacy Practice I
have received a copy of your Notice of Privacy Practices containing a more
complete description of the uses and disclosures of my health information as
well as certain rights that I have as a patient. I understand that this
organization has the right to change its Notice of Privacy Practices from time
to time and that I may contact this organization at any time at the address
above to obtain a current copy of your Notice of Privacy Practices.
|