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#CROSSOVER HEALTH SAN CLEMENTE PHONE REGISTRATION#

Any revision or amendment to the Notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. We reserve the right to revise or amend this Notice of Privacy Practices (the “Notice”).

The terms of this notice apply to all records containing your PHI that are created or retained by our practice.

Our obligations concerning the use and disclosure of your PHI.

We realize that these laws are complicated, but we must provide you with the following important information: By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. We are required by law to maintain the confidentiality of health information that identifies you. In conducting our business, we will receive information and create records regarding you and the treatment and services we provide to you. Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI).

PLEASE REVIEW IT CAREFULLY.Īs required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA): A. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. Notice Of Privacy Practices (Effective Date: October 2019)

If you do not wish to be bound by this Agreement, you may not receive any services provided by Crossover Health Medical Group.

#CROSSOVER HEALTH SAN CLEMENTE PHONE REGISTRATION#

By accepting it, you are electronically signing and agreeing to be bound by this New Patient Registration for yourself, if you are the patient, or on behalf of your child, if he or she is the patient, in which case, you acknowledge that you are the parent or legal guardian, and each of the demarcated documents contained herein including: the Notice of Privacy Practices, General Consent and Patient Rights and Responsibilities. Please read this Agreement carefully: It is a legally binding contract.