The
Notice of Privacy Practices outlines how BayCare Clinic will safeguard your Protected Health Information (PHI).
The
Authorization to Disclose PHI allows us to release your medical and/or billing information to your spouse, friends, or other family members if they call on your behalf. Completing this form is optional. If you choose not to complete it, we will only release medical or billing information to
you.
The
Restriction Agreement: When you allow specific individuals access to your medical information, you can restrict the release of specific diagnoses, lab tests, procedures, etc. by completing this form.
By completing and signing the
Authorization for Release of Medical Information, it authorizes us to release a copy of your medical records to you.
