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"healthviewOne provider network"

Medical Care & Telehealth
Provider ID: 29573588


Next generation health care

a healthviewone provider network

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Consent to share health information
Does the HIPAA Privacy Rule permit doctors, nurses, and other health care providers to share patient health information for treatment purposes without the patient's authorization?

Answer:
Yes. The Privacy Rule allows those doctors, nurses, hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information, such as X-rays, laboratory and pathology reports, diagnoses, and other medical information for treatment purposes without the patient's authorization. This includes sharing the information to consult with other providers, including providers who are not covered entities, to treat a different patient, or to refer the patient.
healthcare.gov


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Notice of privacy practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This notice is being provided to you in accordance with the requirements of the Standards of Privacy of individually identifiable Health Information Portability and Accountability Act(HIPAA) and by the amendments to the HIPAA Privacy Rules made by the Health Information Technology for Economic and Clinical Hesalth Act of 2009 (HITECH Act).

I acknowledge that I have been provided with Flex 4 Medical Center Notice of Privacy Practices that provides a more complete description of information uses and disclosures. I understand that I have the right to review the Notice of Privacy Practices prior to signing this consent. I understand that F4M reserves the right to change its Notice of Privacy Practices and prior to implementation will mail a copy of any revised notice to the address I have provided.

By signing this form, I consent to F4M use and disclosure of my health information for treatment payment and health care operations.


Patient informed consent for electronic medical services

F4M has implemented an electronic health record in part to meet the U.S. Department Health and Human Services initiative to improve health information technology, toward the goal of improving quality of health care. Our electronic health record integrates your clinical record with appointments, registration, and billing and makes this information available to the clinicians who are involved in your care.

In connection with its ecectronic communication systems, F4M has also implemented and has in place privacy ans security policies and procedures to minimize risk of ininadvertant or unaithorized disclosure, corruption and/or loss or distortion of data, but as with all record keeping systems, wether paper or digital, some risks remain of loss, inadvertant disclosures or errors in the recorded data.

I have read and understand the information provided regarding Electronic Medical Services, have discussed it with my physician, his/her assistants, or designee, and all of my questions have been answered to my satisfaction.

I hereby give my informed consent for the use of Electronic Medical Services in the course of my diagnosis and treatment and consent to the electronic communication of my personal health care information to other entities for treatment payment or health care operations, including electronic transfer of medical data to other medical practitioners participating in my medical care.

Informed consent for prescriptions

F4M continues its position as the network exchange for the flow of vital patient information to physicians and other health care providers. It is essential to improve patient safety and the continuity of care with electronic connectivity between payers, physicians and pharmacists. F4M Electronic Health Record(EHR) provides secure access for patients with commercial prescription coverage in the United States.

Prescription eligibility, benefit, formulary and medication history information is provided for consenting patients to authorized physicians at the point of care. Electronic prescriptions are delivered in real-time to pharmacists in the retail and mail order settings.

I consent to electronic prescriptions and acknowledge that F4M will use electronic connectivity between payers, physicians and pharmacists.


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Authorization for release of patient's protected health information (PHI)

This information is to be release
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Authorization Release
I understand the information released as a result of the Authorization may be subject to re-disclosure and no longer protected by federal or state laws applying to medical information release.

I understand that there may be a fee for copying of my medical records if it it is to be used for other than continuance of health care with another provider.

I understand that this Authorization may be revoked in writing at any time. I understand that revocation will apply only to releases of information made after the date of my revocation.

Unless otherwise indicated, this authorization will expire twelve(12) months from the date of signature. A photocopy of this authorization will be considered as valis as the original. I understand that I will be provided a copy of this Authorization upon request.

I understand and agree that my medical record will be maintained in an electronic medical record(EMR) format and that records may be transmitted electronically via fax, email, Internet or data transfer system.




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Incident#: 224629852

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