HIPAA Forms

The Notice of Privacy Rights describes how medical information about you may be disclosed, and how you can get access to this information. As our patient, under HIPAA (the new federal privacy act), you have specific privacy rights. We are required by law to provide you a copy of the notice and obtain your signature verifying that we did so. Each patient will be given this notice upon arrival in one of our offices, and will be asked to sign an acknowledgement of receipt.

If you would like to obtain the Privacy Notice and sign the acknowledgement form prior to your arrival, you may download them both now, read the notice, print the acknowledgement form, sign it, and bring it into the office with you. The forms are pdf (portable document format) files which require the free Adobe Reader.

English
Notice of Privacy Rights (print and read)
Acknowledgement of Receipt (print, sign, and bring with you)

Spanish
Notificación de Los Derechos de Privacidad (imprimir y leer)
Afirmación del Recibo (imprimir, firma, y llevatclo contigo)