HB Podiatry Group
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MEDICARE AUTHORIZATION
IN CASE OF EMERGENCY, CONTACT:
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I hereby authorize the use and disclosure of individually identifiable health information relating to me, which is "protected Health Information" (PHI) under a federal health privacy law, for the purpose of treatment, payment and healthcare operations. PHI is basically health information that is identifiable to an individual and this is transmitted or maintained in any form or medium, including oral, paper, or electronic, by a health care provider, (Healthcare provide includes any person or organization who furnishes, bills, or is paid for health care in the normal course of business. Provider includes physicians and all staff) PHI can be more than just medical records and charts. PHI includes information that relates to treatment, health condition, payment and even demographics information such as name, address and age. Disclosed PHI will cover all dates of service performed by the doctors and staff from HB Podiatry Group, at the office or patient's home.
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