HIPAA Privacy Authorization Form (Hold)

HIPAA is an acronym for “Health Insurance Portability and Accountability Act.”

HIPAA was implemented by the federal government to ensure the privacy and confidential handling of medical information for all patients in the U.S. It applies to all medical and mental health service providers.

HIPAA requires that all inviduals be notified of their right to privacy and receive a “Notice of Privacy Practices” which is sometimes also called “Notice of Information Practices.”

The notifications are meant to inform you how your health information is used. 

A HIPAA consent form may signed by your to show that you have received a copy of our privacy practices.

SEE OUR NOTICE OF PRIVACY POLICIES.

LINK TO AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (PDF)

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Last updated: 9/9/2020