Privacy of Health
Notice of Privacy
Practices
Notice describing the company's policies regarding patient's
personal health information.
Authorization
Form to be completed by patient to request that individually
identifiable health information be received or disclosed by a
specified person or entity.
Request for Access to Designated
Records
Form to be completed by patient to request access to the health
information contained in the records maintained by the Company.
Request for
Restrictions
Form to be completed by patient to request restricted uses or
disclosures of protected health information.
Request for Confidential
Communications
Form to be completed by patient to request an alternative
means of communicating protected health information.
Request for Amendment to Designated
Records
Form to be completed by patient to request that the health
information contained in the company's records be amended.
Request for an
Accounting
Form to be completed by patient to request an accounting of
the disclosures made by the Company of patient's protected health
information.
Complaint under Privacy Rule
Form to be completed by anyone wishing to file a complaint
against the Company's actions, policies or procedures with respect
to the Privacy Rule and/or individually identifiable health
information.