AUTHORIZATIONS & ACKNOWLEDGEMENTS
ACKNOWLEDGEMENT OF PRIVACY PRACTICES AND CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION
Private Practices: I (the patient) have the right to read the Privacy Practices. A copy of the Notice and/or this consent is available upon request and anytime on our website. The Notice provides a description of our practice’s treatment, payment activities, healthcare operations and the uses and disclosures we make of your protected health information.