Under the Health Insurance Portability and Accountability Act of 1996 (HIPPA), you have certain privacy rights concerning your health care information. Under this law, your health care provider generally cannot give your information to your employer, or share your
information for marketing or advertising purposes, without your written consent. It is important that you understand that your information can be used and shared in the following ways.
- To Inform multiple health care providers who may be involved in your treatment directly and indirectly.
- To inform your family, friends, relatives, or others that you identify, who are involved in your health care or heath care bills.
- Threats to health and safety that involves you harming yourself or others
- To make required reports to the police
- To provide information about employees, to employers, regarding worker’s compensation
- To obtain payment from third party payers.
I acknowledge that I have received and read a copy of my HIPPA privacy rights. And I agree to have thisinformation released to my medical doctor. (This permission may be revoked at any time!)