Many of these documents are in pdf format and will require the Adobe Acrobat reader to view them.
Notice of Privacy Practices
Notice describing the company's policies regarding customer's
personal health information.
Authorization
Form to be completed by customer to request that individually
identifiable health information be received or disclosed by a
specified person or entity.
Request for
Access to Designated Records
Form to be completed by customer to request access to the health
information contained in the records maintained by the Company.
Request for
Restrictions
Form to be completed by customer to request restricted uses or
disclosures of protected health information.
Request for
Confidential Communications
Form to be completed by customer to request an alternative means
of communicating protected health information.
Request for Amendment
to Designated Records
Form to be completed by customer to request that the health
information contained in the company's records be amended.
Request for an
Accounting
Form to be completed by customer to request an accounting of the
disclosures made by the Company of customer's protected health
information.
Complaint under Privacy Rule
Form to be completed by anyone wishing to file a complaint against
the Company's actions, policies or procedures with respect to the
Privacy Rule and/or individually identifiable health
information.
Contact the
Privacy Officer
If you have any questions or concerns, please contact the privacy
officer.