I understand that, under the Health Insurance Portability and Accountability Act of 1996 (HIPPA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:

• Conduct, plan, and direct my treatment and follow-up among the multiple health care providers who may be involved in that treatment directly, indirectly and by delivery.
• Obtain payment from third-party payers.
• Contact normal health care operations such as quality assessments and physician certifications.

I acknowledge that I have received your Notice Of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I understand that this organization at any time at the address to obtain a current copy of the Notice of Privacy Practices. I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment, or health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.

Click here to read our our Privacy Practices