HIPAA Consent

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

We are committed to protecting the privacy and confidentiality of your health information. Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice.

YOU HAVE THE RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION

This means you may inspect and obtain a copy of protected health information about you for so long as we maintain the protected health information. You may obtain your medical record that contains medical and billing records and any other records that your physician and the practice may use for making decisions about you.

DIRECT EMAIL CORRESPONDENCE

By signing this HIPAA Patient Consent Form, you authorize the team at Quality Health Care Concierge to email the protected health information directly to the email provided. You acknowledge that the security and confidentially of an email transmission cannot be guaranteed. Employers and online services have the right to access and archive email transmitted through their systems. If your email is a family address or if others have access to your email, the information may be seen by those individuals or others, therefore, please take note. Because of the many internet and email factors beyond our control, we cannot be responsible for misaddressed, misdelivered, or interrupted email. This is inclusive but no limited to email breaches, hacking, forwarding, 1^st or 3^rd party action, and other such instances leading to transmission of your documentation.

This HIPAA Patient Consent Form and process is fully optional. You have the right and choice not to have the protected health information emailed directly to you and instead have a secure portal link emailed to you where you will be able to register by verifying your identity to access and print/save the documentation.