Hipaa pdf for patients

Accountability Act of 1996 (HIPAA). The patient understands that: Protected health information may be disclosed or used for treatment, payment or health care operations. All other disclosures by the practice will require specific authorization by you unless required bylaw. HIPAA Release Form Please complete all sections of this HIPAA release form. If any sections are left blank, this form will be invalid and it will not be possible for your health information to be shared as requested. Section I I,_____, give my permission for 1. Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately. This specifically includes the sharing of information with other healthcare providers, laboratories, health insurance payers as is necessary and appropriate HIPAA Privacy Standards: April 2003 Protect an individual's electronic billing andhealth information and provide patients with is stored electronically. certain rights Security Standards: Regulations expected shortly. Physical, technical and administrative safeguards of patient information that Codes and Transaction Standards: October 2003 Accountability Act of 1996 (HIPAA). The patient understands that: Protected health information may be disclosed or used for treatment, payment, or health care operations. The Practice has Notice of Privacy Practices and that the patient has the opportunity to review this Notice.