Your Information Is Yours. We May Not Disclose Your Personal Information to Third Parties Without Your Expressed Consent, Except as Outlined in Your Information. Your Rights. Our Responsibilities. Policy. The Following Forms Authorize/direct Us to Disclose Your Information to Third Parties of Your Choosing. If You Want Us to Discuss Your Health Information and Treatment With Family, Friends, or Others in Your Absence, You Will Need to Complete One of the Following Forms. However, You Are in No Way Required to Do So; Your Treatment Will in No Way Be Impacted Whether or Not You Complete and/or Sign Any of the Following Forms.
Any of these authorizations may be revoked at any time, preferably in writing; however, the revocation will not affect any disclosures that occurred before your revocation. Also, if HIPAA doesn't cover the party to which you are directing the disclosure, the information may not be protected from further disclosure by that party.
Disclosure Authorization— This Form Is Used to Tell Us With Whom We Can Disclose Your Medical Information in Your Absence and How.
Telephone Authorization— This Form Tells Us How We Can Leave Messages for You on the Phone. If You Do Not Complete This Form, We Will Simply Leave a Callback Message for You With Whoever Answers, Whether It Is a Person or an Answering Device, E.g., Voicemail.
Records Request— This Form Is Used for Records Requests, Whether for Your Use, Another Medical Office, or an Attorney.