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NOTICE OF PRIVACY PRACTICES FOR Horizon Pediatric Consultants, LLC/Rocking Horse Rehab THIS NOTICE DESCRIBES HOW TREATMENT INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
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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 carefully to understand your rights and how your health information is used and disclosed.
02
Fill in your personal information as requested, including your name, address, and contact information.
03
Sign and date the form to indicate that you have received the notice of privacy practices and understand its contents.
04
Return the completed form to the healthcare provider or organization as instructed.
Who needs notice of privacy practices?
01
Patients who receive healthcare services from a healthcare provider or organization.
02
Individuals who are seeking information about how their health information is used and disclosed.
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What is notice of privacy practices?
It is a document that informs patients about how their health information may be used and disclosed by healthcare providers.
Who is required to file notice of privacy practices?
Healthcare providers, health plans, and healthcare clearinghouses are required to file notice of privacy practices.
How to fill out notice of privacy practices?
The notice must be filled out with information about how patient health information is used, disclosed, and protected.
What is the purpose of notice of privacy practices?
The purpose is to inform patients about their privacy rights and how their health information is protected.
What information must be reported on notice of privacy practices?
The notice must include information about how patient health information is used, disclosed, and protected, as well as patients' rights regarding their health information.
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