HIPAA Laws

Notice of Privacy Practices

Our Notice of Privacy Practices provides information about how we may use or disclose protected health information. The notice contains a patient’s rights section describing your rights under the law. By your initials you acknowledge that you have received GVDC Notice of Privacy Practices.

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Release of Information

The HIPAA (Health Insurance Portability and Accountability Actof 1996) law allows for the use of the information for treatment, payment, or healthcare operations. By your initials,you consent to our use and disclosure of your protected healthcare information for treatment, payment, ordental/healthcare operations. Consent to disclosure of records shall be effective until revoked it in writing.

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Disclosures to Other Individuals (ex: friends, family members to discuss appointments, treatment):

I give permission for my Protected Health Information to be disclosed for purposes of communicating results, findings and care decisions to the individuals listed.

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Notice of Privacy Practices

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Our Notice of Privacy Practices provides information about how we may use or disclose protected health information. The notice contains a patient’s rights section describing your rights under the law. By your initials you acknowledge that you have received GVDC Notice of Privacy Practices.

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