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I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:
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Conduct normal healthcare operations such as quality assessments and physician certifications.
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containing a more complete description of the uses and disclosures of my health information. I have been given the right to review such
Notice of Privacy Practices
prior to signing this consent. I understand that this organization has the right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time at the address above to obtain a current copy of the Notice of Privacy Practices. I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or health care operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions. I understand that I may revoke this consent in writing at any time, except to the extent that you have taken action relying on this consent.
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Home
About Us
Meet Our Staff
Best Cosmetic Dentist in Moscow, ID
Invisalign Provider in Moscow, ID
Same-Day Crowns Near Me
Dental Implants
TOUR
PATIENT FORMS
Paperwork For Patients
Dental Benefits Plan
Contact Us
MY ACCOUNT
Pay Now