Notice of Privacy Practices
Thank you for choosing our practice. Protecting your privacy in the office and outside the office is very important to us. Listed below are office policies that are designed to protect your private health information. Some are required of us by “HIPAA”, a recent set of federal laws designed to protect your privacy. We have prepared this material to acquaint you with our policies. Please sign the bottom after reading.
Release of information to insurance companies
I hereby authorize Robersonville Physicians to provide necessary medical information from my medical records to process insurance claims
Release of information to family members
I understand Robersonville Physicians will not release information to family members without my express verbal or written permission.
Release of information to others
I understand Robersonville Physicians may need to use and disclose my health information without my permission for the following purposes: health emergencies, workers’ compensation claims, public health risks, law enforcement court orders, and selected others as dictated by law.
I understand that I may have access to my medical records, subject to certain restrictions. If I feel there is an error in my medical records, I may request an amendment/correction to my medical records.
I understand that if I have any questions about Privacy Practices and how this information is used, I may ask the Robersonville Physicians privacy officer, Dr. Thomas J. Gennosa.
Thank you for choosing our practice. Protecting your privacy in the office and outside the office is very important to us. Listed below are office policies that are designed to protect your private health information. Some are required of us by “HIPAA”, a recent set of federal laws designed to protect your privacy. We have prepared this material to acquaint you with our policies. Please sign the bottom after reading.
Release of information to insurance companies
I hereby authorize Robersonville Physicians to provide necessary medical information from my medical records to process insurance claims
Release of information to family members
I understand Robersonville Physicians will not release information to family members without my express verbal or written permission.
Release of information to others
I understand Robersonville Physicians may need to use and disclose my health information without my permission for the following purposes: health emergencies, workers’ compensation claims, public health risks, law enforcement court orders, and selected others as dictated by law.
I understand that I may have access to my medical records, subject to certain restrictions. If I feel there is an error in my medical records, I may request an amendment/correction to my medical records.
I understand that if I have any questions about Privacy Practices and how this information is used, I may ask the Robersonville Physicians privacy officer, Dr. Thomas J. Gennosa.