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Privacy of Health for California Residents

Notice of Privacy Practices

Notice describing the company's policies regarding patient's personal health information.

Authorization

Form to be completed by patient to request that individually identifiable health information be received or disclosed by a specified person or entity.

Request for Access to Designated Records

Form to be completed by patient to request access to the health information contained in the records maintained by the Company.

Request for Restrictions

Form to be completed by patient to request restricted uses or disclosures of protected health information.

Request for Confidential Communications

Form to be completed by patient to request an alternative means of communicating protected health information.

Request for Amendment to Designated Records

Form to be completed by patient to request that the health information contained in the company's records be amended.

Request for an Accounting

Form to be completed by patient to request an accounting of the disclosures made by the Company of patient's protected health information.

Complaint under Privacy Rule

Form to be completed by anyone wishing to file a complaint against the Company's actions, policies or procedures with respect to the Privacy Rule and/or individually identifiable health information.