As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act (HIPAA)
1. The purpose of the attached Notice of Privacy Practices (Notice) is to tell you how we can use and disclose your medical information. It also describes certain rights that you have about your medical information kept by us. Please look at it with care.
2. We are legally required to give you this Notice and to get a signed statement that you received it. By signing this, you are only saying that you have received our Notice.
3. This Notice also sets forth the name and contact information for the person you can contact if you have any questions. It tells you how to file a complaint if you think your rights have been denied. It also tells you how to file a complaint about our practices described in the Notice.
By signing this paper, you confirm receipt of the SAFEchild Advocacy Center Notice of Privacy Practices.