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Cathy HenschelMcGerry, MA, MHC, LEFT 1026 NE 95th St. Seattle, WA 98115NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
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How to fill out notice of privacy practices
How to fill out notice of privacy practices
01
Read and understand the notice of privacy practices provided by the healthcare provider.
02
Complete any sections requiring your personal information, such as name, address, and contact information.
03
Sign and date the notice to acknowledge that you have received and understood it.
04
Keep a copy of the notice for your records.
Who needs notice of privacy practices?
01
Patients receiving healthcare services from a healthcare provider.
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What is notice of privacy practices?
The notice of privacy practices is a document that explains how a healthcare provider may use and disclose a patient's protected health information.
Who is required to file notice of privacy practices?
All healthcare providers, including doctors, hospitals, and clinics, 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 including information on how the healthcare provider will use and disclose protected health information, patient rights, and how to file a complaint.
What is the purpose of notice of privacy practices?
The purpose of the notice of privacy practices is to inform patients about their rights regarding their protected health information and how it may be used or disclosed.
What information must be reported on notice of privacy practices?
The notice of privacy practices must include information about how a healthcare provider may use and disclose a patient's protected health information, as well as the patient's rights regarding their information.
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