CONSENT TO USE OR DISCLOSE HEALTCH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS(HIPPA DOCUMENT COMPLIANCE)

In the course of providing service to you, we create, receive, and store health information that identifies you. It is often necessary to use and disclose this information in order to treat you, to obtain payment for services, and to conduct health care operations involving our office.
We have a comprehensive Notice of Privacy Practices that describes these uses and disclosures in detail. It is available for your review at the office and you are free to refer to this Notice at any time before you sign any cosent document at our office.
The use and disclosure of your health information for treatment purposes not only includes care and services provided at our office, but also dislcosures of your health information may be necessary or appropriate for you to receive follow-up care from another health care professional. Similarly, the use and disclosure of your health information for purposes of payment includes submission of your health information to a billing agent or vendor for processing claims or obtaining payments among other aspects of payment described in our Notice of Privacy Practices.
You have the right to ask us to restrict the uses or disclosures made for purposes of treatment, payment or health care operations, but as described in our Notice of Privacy Practices, we are not obligated to agree to these suggested restrictions. If we do agree, however, the restrictions are binding on us.
Please talk to the office personnel in charge if HIPPA requirements should you have any further questions or concerns.