I understand that as part of my care, Talk Time, Angela Martini, MS, CCC-SLP, PA creates and maintains health records that describe my health history, symptoms, examinations, test results, diagnosis, procedures, treatment, and plans for future care or treatment I may receive. I understand that health information collected and stored will be used for the following:
- To support my care and treatment at Talk Time, Angela Martini, MS, CCC-SLP, PA (treatment)
- For continued treatment among health professionals who are involved and contribute to my health care (treatment)
- For billing purposes including information regarding my diagnosis, treatment, and services rendered (payment)
- For insurance claim processing by a third-party payers for verification of services billed (payment)
- A tool for routine healthcare operations such as assessing quality improvement (healthcare operations)
I understand that the Notice of Privacy Practices from Talk Time, Angela Martini, MS, CCC-SLP, PA defines more information regarding the use and disclose of my protected health information as well as my rights to my health information. By signing this, I acknowledge that Talk Time, Angela Martini, MS, CCC-SLP, PA has offered me a copy of their Notice of Privacy Practices. I acknowledge and understand the rights that I have over my protected health information. I authorize the use and disclosure of my protected health information as specified in the Notice of Privacy Practices. I authorize the use and disclosures for treatment, payment, and healthcare operations purposes for Talk Time, Angela Martini, MS, CCC-SLP, PA.