Our Notice of Privacy providers information about how we may use or disclose protected health information. We are happy to provide you with a copy of the HIPAA privacy Act.
The notice contains a patient's right section describing your rights under the law. You ascertain that by your signature that you have reviewed our notice before signing this consent.
The terms of the notice may change, if so you will be notified at your next visit to update your signature/date.
You have the right to restrict how your protected health information is used and disclosed for treatment, payment or healthcare operations. We are not required to agree with this restriction, but if we do, we shall honor the agreement.
The HIPAA (Health Insurance Portability and Accountability Act of 1996)law allows for the information for treatment, payment, or health operations.
By signing this form, I understand that:
Chiropractic services may be delivered in an open door room described in the office privacy notice.
The practice may contact you by phone, text or email to remind you of appointments or upcoming events.
The practice reserves the right to change the privacy policy as allowed by the law.
The practice has the right to restrict the use of the information but the practice doesn;t have to agree to those restrictions.
The patient has the right to revoke this consent in writing at any time and all full disclosures will then cease.