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What is HIPAA?
How does this apply to you?
New Patient Forms
What is HIPAA?
HIPAA is the Health Insurance Portability and Accountability Act signed into law in 1996. Its primary purpose is to provide continuous insurance coverage for workers who change jobs. An Administrative Simplification section in the law requires adoption of standards for security, privacy and electronic healthcare transactions.
How does this apply to you?
The Silicon Valley Sarcoma Center
at Stanford is fully compliant with
HIPAA regulations.
This notice describes how your health information may be used and disclosed and how you can access this information. Please review carefully.
We (staff) and David Mohler, M.D. have always kept your health information secure and confidential. A new law went into effect April 14, 2003 that requires us to continue maintaining your privacy, to give you this notice and to follow the terms of this notice.
The law permits us to use or disclose your health information to those involved in your health care treatment.
We may use or disclose your health information for payment of your services.
Dr. David Mohler's billing office may need to submit additional medical documentation in order to appeal your claim with our office. We may need to provide your medical records to other outside health care providers in order to coordinate the best health care for you. We may need to share your medical information in order to refill prescriptions or order additional healthcare with outside agencies.
We may need to contact you and leave information on your answering machine. We will only leave pertinent information on your answering machine.
In an emergency, we may disclose your health information to an immediate family member or a legally responsible party for your health care. When required by law, we will release your medical records.
You are entitled to a copy of this HIPAA privacy statement.
For more info, see www.hipaaprep.org
New Patient Forms
Please print and fill out the following forms before your first appointment.
The follwing links will open in a PDF.
HIPAA Information Notice
HIPAA Privacy Form
New Patient Information Form
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