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Patient Privacy Notice – HIPAA

This form addresses your rights to the confidentiality of your medical record and usage of the information for the provision health care to you by our office and other providers (under the Health Insurance Portability and Accountability Act). In this form, it’s important that you indicate any restrictions to disclosure, as well as to identify family members or others that may be allowed to know information about your medical condition. Additionally, we ask that you advise us of acceptable methods with which to leave messages or provide information to you about your health care.

pdf podiatry patient form downloadPatient Privacy HIPAA Notice

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