1)You agree to the normal procedures utilized within the office for handling of charts, patient records, PHI and other documents or information.
2. It is the policy of this office to remind patients of their appointments by text phone and email.
3.We may send you other communications informing you of changes to office policy and new technology that you might find valuable or informative.
3. The practice utilizes a number of vendors in the conduction of business. These vendors may have access
to PHI but must agree to abide by the confidentiality rules of HIPAA
4. You agree to bring any concerns or complaints regarding privacy to the attention of the office manager.
5. We agree to provide patients with access to their records in accordance with state and federal laws.
6. We may change, add, delete or modify any of these provisions to better serve the needs of both the practice and patient at any time without notice.
7. You have the right to request restrictions in the use of your protected health information and to request
change in certain policies used with the office concerning your PHI. However, we are not obligated to alter internal polices to conform to your request. I, do hereby consent and acknowledge my agreement to the terms set forth in the HIPAA INFORMATION FORM and any subsequent changes in office policy.
8. I understand that this consent shall remain in force from this time forward. As affixing my signature electronically on this form.