I understand that the patient's health information is private and confidential. I understand that A Family Healing Center works very hard to protect the patient's privacy and preserve the confidentiality of the patient's personal health information.
I understand that A Family Healing Center may use and disclose the patient's personal health information to help provide health care to the patient, to handle billing and payment, and to take care of other health care operations. In general, there will be no other uses and disclosures of this information unless I permit it. I understand that there may be situations where A Family Healing Center is required by federal, state, or local law to release this information without my permission. One example would be in response to a warrant, summons, court order, subpoena or similar legal process.
A Family Healing Center has a detailed document called the "HIPAA Patient Rights". It contains more information about the policies and practices protecting the patient's privacy including other potential disclosures and uses of patient's health information. I understand that I can receive a copy of this document at any time of my choosing. The document is also available on our website. CLICK HERE. I understand that I have the right to read the "HIPAA Patient Rights" before signing this Acknowledgment.
A Family Healing Center may update this Acknowledgment and "HIPAA Patient Rights". If I ask, A Family Healing Center will provide me with the most current "HIPAA Patient Rights". Within this "HIPAA Patient Rights" is contained a complete description of my privacy/confidentiality rights. These rights include, but are not limited to, access to my medical records; restrictions on certain uses; receiving an accounting of disclosures as required by law; and requesting communication be it by specified methods of communications or alternative locations.
A Family Healing Center has established procedures that help them meet their obligations to patients. These procedures may include other signature requirements, written acknowledgments, and authorizations; reasonable time frames for requesting information; charges for copies and non-routine information needs; etc. I will assist A Family Healing Center by following these procedures if I choose to exercise any of my rights described in the "HIPAA Patient Rights".