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Winslett Walls Dental Excellence 7643 Market Street Wilmington NC 28411 910 686-9802 www. winslettwalls. Com Drs. Wesley Winslett Todd Walls Ashley Basinger and Michael Levine and Mary Ruth Marshall welcome you to our practice. Requests may be directed to Phyllis Murray Privacy Officer Winslett Walls Dental Excellence 7643 Market St. Wilmington NC 28411 910-686-9802. Wes Winslett Todd Walls Ashley Basinger Michael Levine Mary Ruth Marshall info winslettwalls. com RELEASE OF DENTAL INFORMATION...
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How to fill out iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofpriva
How to fill out iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices
01
Start by obtaining a copy of the notice of privacy practices from Winslett & Walls Dental Excellence.
02
Read the notice thoroughly to understand its content and purpose.
03
Fill out your personal information accurately at the top of the form, including your name, address, and contact details.
04
Proceed to the acknowledgement section where you will need to check the box indicating that you have been made aware of the notice of privacy practices.
05
Sign and date the form to indicate your agreement and understanding of the privacy practices.
06
If there are any additional fields or sections on the form, make sure to complete them accurately as required.
07
Return the completed form to Winslett & Walls Dental Excellence as per their instructions.
Who needs iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
01
Anyone who receives dental services from Winslett & Walls Dental Excellence needs to acknowledge that they have been made aware of the notice of privacy practices.
02
This includes both new and existing patients of the dental practice.
03
Acknowledging the notice is important to ensure that patients understand the privacy policies and procedures implemented by the dental office for the protection of their personal health information.
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What is iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
The notice of privacy practices outlines how Winslett & Walls Dental Excellence may use and disclose your protected health information.
Who is required to file iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
All patients of Winslett & Walls Dental Excellence are required to acknowledge the notice of privacy practices.
How to fill out iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
Patients can fill out the acknowledgment by signing and dating the form provided by Winslett & Walls Dental Excellence.
What is the purpose of iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
The purpose of the acknowledgment is to ensure that patients understand how their protected health information may be used and disclosed by the dental practice.
What information must be reported on iacknowledgethatihavebeenmadeawareofwinslettampwallsdentalexcellencesnoticeofprivacypractices?
The acknowledgment form typically includes the patient's name, date of birth, and signature.
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