RELEASE OF MEDICAL INFORMATION

Under Federal HIPAA regulations, we will release information from your medical record to your insurance carrier if required in order to process our claim for services we provided; to your primary care physician or other referring physician(s) to provide continuity of care; and in certain other circumstances specifically permitted by HIPAA rules, without prior written authorization from you.

If you wish to have us release information from your medical record to other individuals or organizations, you will need to sign an authorization specifying the information to be released and to whom it is to be released. There may be a charge for release of information in certain circumstances.