New Patient Registration

In 1996, The US Department of Health and Human Services issued the Health Insurance Portability and Accountability Act (HIPPA). This act essentially regulates how health related information (what has come to be known as "covered transactions") are electronically transmitted. Furthermore, a series of other provisions with respect to patient privacy and security standards have been issued, and were instituted April 14, 2003. This is a summary of the ways in which medical information about you may be used and disclosed, and how you can get access to this information. Dr. Portnoy, his associates, and his entire staff will user your medical information as part of rendering patient care. Your medical information may be used for treatment, payment or health care operations. For exampled, your medical information may be used by the health care professional treating you, by the office insurance coordinator to process your payment for the services rendered, and by administrative personnel reviewing the quality and appropriateness of the care you receive. Your information may also be disclosed pursuant to applicable federal and state law.

The complete notice of Privacy Practices is prepared for your review. We encourage you to read the entire Notice. You are required to acknowledge in writing that you have a read a copy of the Notice. A copy of this document will be maintained in your medical record. The attached Notice is effective as of April 14, 2003.

In selecting this checkbox you acknowledge receipt and acceptance of our privacy practices for protected health information.