To expedite your check-in process, please have your insurance card and driver’s license available.

Prior to check in, you may also review our HIPPA information and consent policies. This describes how medical information about you may be used, disclosed, and how you can obtain access to such information.

HIPAA INFORMATION AND CONSENT – PLEASE REVIEW THIS NOTICE CAREFULLY

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy.  Implementation of HIPAA requirements officially began on April 14, 2003.  This is a user friendly explanation; however, more information is available from the US Department of Health and Human Services at:  www.hhs.gov

There are rules and restrictions on who may see or be notified of your Protected Health Information (PHI).  These restrictions do not include the normal interchange of information necessary to provide you with office services.  HIPAA provides certain rights and protections to you as the patient.  This is balanced with the needs of providing quality professional services and care.  We strive to take reasonable precautions to protect your privacy.

The following policies are implemented at our facility:

  • Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately.  This specifically includes the sharing of information with other healthcare providers, laboratories, health insurance payers as is necessary and appropriate for your care.  Patient files may be stored in open file racks and will not contain any coding which identifies a patient’s condition or information which is not already a matter of public record.  The normal course of providing care means that such records may be left, at least temporarily, in administrative areas such as the front office, examination room, etc.  Those records will not be available to persons other than office staff. 
  • It is the policy of this office to remind patients of their appointments.  We may do this by telephone, email, US mail, or by any means convenient for the practice and/or as requested by you.  We may send you other communications informing you of changes to office policies and new technologies you might find valuable or informative.
  • The practice utilizes several vendors in the conduct of business.  These vendors may have access to PHI but must agree to abide by the confidentiality rules of HIPAA.
  • You understand and agree to inspections of the office and review of documents which may include PHI by government agencies or insurance payers in normal performance of their duties.
  • You agree to bring any concerns or complaints regarding privacy to the attention of the office manager or health care provider.
  • Your confidential information will not be used for the purpose of marketing or advertising of products, goods or services without your prior consent.
  • We agree to provide patients with access to their records in accordance with state and federal laws.
  • We may change, add, delete or modify any of these provisions to better serve the needs of both the practice and patient.
  • You have the right to request restrictions in the use of your protected health information and to request change in certain policies used within the office concerning your PHI. We are not, however, obligated to alter internal policies to conform to your request. 
  • You understand that you have the right to revoke this authorization, in writing, at any time, except where uses or disclosures have already been made based upon your original permission.  You may not be able to revoke this authorization if its purpose was to obtain insurance. In order to revoke this authorization, you must do so in writing and send it to the appropriate disclosing party.
  • You understand that it is possible that information used or disclosed with your permission may be re-disclosed by the recipient and is no longer protected by the HIPAA Privacy Standards.
  • You understand that treatment by any party may not be conditioned upon my signing of this authorization and you have the right to refuse to sign this authorization.
  • A copy of this information and/or may be provided to you upon request.