Use & Processing · Permission or license
The signer agrees to Practice’s HIPAA Notice and consents to use and disclosure of health information
The signer acknowledges having read and agrees to Practice’s HIPAA Notice of Privacy Practices, which the Consent links to. The signer consents to Practice’s use and disclosure of their protected health information in accordance with that Notice and applicable law, including for treatment, payment and health care operations purposes.
Supporting quotations
I acknowledge that I have read and agree to Practice’s HIPAA Notice of Privacy Practices
I consent to Practice’s use and disclosure of my protected health information in accordance with its HIPAA Notice of Privacy Practices and applicable law, including for treatment, payment, and health care operations purposes
Qualifications & exceptions
- Use and disclosure must be in accordance with the Notice and applicable law.
- Treatment, payment and health care operations are listed with “including,” so the list is not limited to them.
Not stated here
- The Notice of Privacy Practices is linked but its text is not supplied in this document, so what it permits is not analyzed here.