Per federal law, Concierge Health & Rejuvenation Solutions, LLC is committed to protecting the privacy of your medical information, neither this company nor its employees or owners or assignees will release any medical or financial information to any person or agency without the expressed written or witnessed consent of the Responsible party designated above.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that governs the use and disclosure of a person’s health information. Our “Notice of Private Practice” provides information about how we may we disclose protected health information about you. The Notice contains a “Patient Rights “describing your rights under the law. The following statements cover the basics of your rights as a patient under HIPPA.
Protected health information may be disclosed or used for treatment, payment, or health care operations.
We have a Notice of Private Practice and you have the right to review a detailed copy of our Notice before signing this HIPAA Patient Consent.
We reserve the right to change the terms of our Notice of Private Practices
If we change our Notice, you may obtain a revised copy by contacting our office.
You have the right to restrict the uses of your protected health information.
You may revoke this HIPAA Consent in writing at any time. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent.