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NOTICE OF PRIVACY PRACTICES Richard E. Repass, MD Revolution Psychiatric and Addiction Treatment 2737 78th Avenue SE Suite 100 Mercer Island, WA 98040 Effective Date: 8/8/2018 THIS NOTICE DESCRIBES
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How to fill out notice of privacy practices
How to fill out notice of privacy practices
01
Read the notice of privacy practices provided by the healthcare provider carefully.
02
Fill out any required personal information such as name, date of birth, and contact information.
03
Sign and date the acknowledgment stating that you have received the notice of privacy practices.
Who needs notice of privacy practices?
01
Patients receiving healthcare services from a healthcare provider.
02
Employees of healthcare providers who handle protected health information.
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What is notice of privacy practices?
The notice of privacy practices is a document that explains how a health care provider or health plan will handle an individual's protected health information.
Who is required to file notice of privacy practices?
Health care providers and health plans are required to file notice of privacy practices.
How to fill out notice of privacy practices?
The notice of privacy practices can be filled out by providing information about how the organization will use and disclose protected health information, as well as individual rights.
What is the purpose of notice of privacy practices?
The purpose of the notice of privacy practices is to inform individuals about their rights regarding their protected health information and how it will be used and disclosed.
What information must be reported on notice of privacy practices?
The notice of privacy practices must include information about how protected health information will be used and disclosed, as well as individual rights under HIPAA.
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