Notice Of Privacy Practices Acknowledgement

Please correct the errors described below.

I understand that under the health insurance portability and accountability act of 1996 (“HIPAA”). 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 healthcare providers who may be involved in that treatment directly or indirectly
  • Obtain payment from third-party payers.
  • Conduct normal healthcare operations such as reminders of appointments for continuing or follow up care.

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