Important Forms



                                                                                   

The HIPPA Privacy Rule established in 1996 provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.
The forms below follow the guidelines required by law as well as establishing a contract with me for our work together. If you would like more information about the laws, you may go to www.hhs.gov/ocr/privacy
                                                                          
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Please fill out this form if you would like to have your medical information shared between myself, another specified medical provider or insurance carrier. I would request or share information only after your permission is given.       87k v. 3 Oct 9, 2014, 1:52 PM Heather Chatfield
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Please fill this form out as a means of acknowledging and accepting the terms of canceling a scheduled appointment with me.    45k v. 3 Apr 27, 2012, 5:18 AM Heather Chatfield
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This notice describes how medical and other personal information about you may be used and disclosed. It also describes how you can get access to this information. Please review the notice carefully.   113k v. 3 Oct 9, 2014, 1:53 PM Heather Chatfield