All patients rights are protected by Federally Mandated Health Insurance Portability and Accountability Act (HIPPA) laws. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
Protected health information means health information, including demographic information, collected from me and created or received by:
- Another Health Care Provider
- Health Care Clearinghouse
- Health Plan
- My Employer
- My Physician
This protected health information relates to my past, present or future physical or mental health or condition and identifies me, or there is a reasonable basis to believe the information may identify me.
Read the notice of privacy practices (PDF) for more information.
Obtaining a Report Copy
We will only release a copy of the report directly to the patient, Medical Power of Attorney or HIPPA Release form submitted by a third party.
- Public Records Request Form completed
- Proof of identification
- Verification of the incident
- Approved HIPPA release form (If requested from a third party)
- Report will NOT be mailed, you must appear in person to receive a copy
If you have question about obtaining a copy, please call our office at 937-233-1564.