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Notice of Privacy Practices
and Acknowledgment
6510 Capitol Blvd SE Tum water, WA 98501
P: 360.352.6060
F: 360.357.7339
Douglas N Jesse, OD, Privacy Official
Effective Date: April 20, 2021We respect
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01
Read the notice of privacy practices thoroughly to understand the information being provided.
02
Fill out any required personal information such as your name and contact details.
03
Sign and date the notice to acknowledge that you have received and understood the privacy practices.
Who needs notice of privacy practices?
01
Anyone who receives healthcare services or treatment from a healthcare provider, as they are required by law to provide patients with a notice of privacy practices.
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What is notice of privacy practices?
A notice of privacy practices is a document that outlines how a healthcare provider or organization may use and disclose a patient's private health information (PHI) and informs patients of their rights regarding their information.
Who is required to file notice of privacy practices?
Healthcare providers, health plans, and healthcare clearinghouses that handle protected health information are required to provide a notice of privacy practices.
How to fill out notice of privacy practices?
To fill out a notice of privacy practices, organizations must include details such as their privacy practices, the types of information collected, how it may be used or disclosed, and patient rights. It's essential to ensure clarity and compliance with HIPAA regulations.
What is the purpose of notice of privacy practices?
The purpose of a notice of privacy practices is to inform patients about their privacy rights, how their health information will be used, and what protections are in place for their personal health information.
What information must be reported on notice of privacy practices?
The notice must report information about how medical information may be used, disclosures that may be made, patient rights, the organization's legal duties, and whom to contact for more information.
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