I understand that I have certain rights to privacy regarding my protected health information (PHI). These rights are given by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). By signing this consent, I authorize Belle Meade Addiction Medicine & Psychiatry, PLLC to use and disclose my PHI to administer treatment, day-to-day operations of the practice and medical record keeping stored in a HIPAA-compliant EMR.
Belle Meade Addiction Medicine & Psychiatry, PLLC may use vendors who have access to my PHI and agree to comply with HIPAA.
I have been informed of and given the right to review and secure a copy of the Notice of Privacy Practices, which contains a description of uses and disclosures of my PHI and rights under HIPAA. I understand that Belle Meade Addiction Medicine & Psychiatry, PLLC may change terms of this notice and that I may obtain an updated copy.