For New Patients

READ THE FOLLOWING (items in RED):

New patients or returning patients who have not gone through the new patient process should read the following items.

▶ New Patient Letter ▶ Financial Service Guidelines ▶ Notice Of Privacy Practices (HIPAA)

PRINT AND FILL OUT THE FOLLOWING (items in GREEN):

In order to make your first visit to our office as convenient for you as possible, we encourage you to print, read, and fill out the registration, appropriate history, and both HIPAA acknowledgement forms before you arrive.

Bring the completed forms when you come for your office appointment.

▶ Patient Registration Form ▶ Adult Patient History Form ▶ Pediatric Patient History Form ▶ HIPAA Privacy Practices Acknowledgement ▶ HIPAA Authorization For Use And Disclosure Of Protected Health Information

About HIPAA:

The federal Health Insurance Portability and Accountability Act (HIPAA) exists to protect your rights to the privacy of your health care information. In order for Neurology Group to maintain your medical record and coordinate your care, we need your permission.

The "HIPAA Privacy Practices Acknowledgement" form indicates that you have read and understand the "Notice Of Privacy Practices". The "HIPAA Authorization For Use And Disclosure Of Protected Health Information" form allows our physicians and staff to discuss the contents of your medical record with those you designate and your primary contact information.