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Summary of Privacy Policies and Forms
Privacy Policies
The following documents summarize our policies to protect your privacy in regards to your children's medical histories. We are fully
compliant with the new HIPAA regulations as specified by the government. For full HIPAA information and regulations,see: http://www.cdc.gov/nip/registry/pcs.htm#1.
We will need the following documents (marked by an *) read and an acknowledgement form filled out when you come into the office for the first time. You can save time if you print them here, read, and sign the form, and bring them with you to the office.
Authorization to Disclose Health Information *
Notice of Disclosure to Employers
Request for Medical Record Release
Release of Confidential HIV Related Information
Revocation of Medical Record Release form
Authorization to Use Photographs
