P.R.I.M.A., Inc. 2178 Mendon Rd, Suite 100 Cumberland, RI 02864 P: (401) 333-5201, F: (401) 333-5215
This notice describes how information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
Patients have been granted individual rights under the HIPPA Legislation. These include the following.
You will be asked to initial an acknowledgement of receipt of the Notice of Privacy Practices. You will Also be asked to outline or define specific instances or information that you would like kept completely confidential (between you and the organization). If you have any questions regarding this Notice of Privacy Practices, please do not hesitate to contact our Privacy Officer for more information or clarification.
By initialing below, I acknowledge that I have received a copy of P.R.I.M.A., INC.’s Notice of Privacy Practices.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use: