I hereby authorize Dr. John Enger DPM to use or disclose my Personal Health Information (PHI) as described below. I understand that, if the organization authorized to receive my PHI is not a health plan or health care provider, the released PHI may use and disclose this protected health information. You have a legal right to review our Notice of Privacy Practice. It is available upon request.
Patient authorizes communication with family/friends regarding your care and test results.
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Patient authorizes communication with family / friends regarding your account and billing.
Patient authorizes communication with a primary care physician or other physician (first and last name):
Best way to contact you regarding messages, responses, appointment reminders etc.
You have the right to revoke this consent in writing, except to the extent we already have used or disclosed your PHI in reliance on your consent.
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