Get Patient Privacy Consent Form I - New River Eye Care

The PATIENT PRIVACY CONSENT FORM I is essential for ensuring the confidentiality and appropriate sharing of your health information at New River Eye Care. This guide provides clear, step-by-step instructions to help you complete the form online with confidence and ease.

Follow the steps to fill out your form easily and securely.

1. Select the ‘Get Form’ button to access the PATIENT PRIVACY CONSENT FORM I and open it for completion.
2. In the first section, provide your name where indicated to express your permission for sharing health information.
3. List names of individuals with whom your health information may be shared, ensuring you fill in all four blank spaces with the appropriate names.
4. Indicate your preferred method of communication by checking the boxes for home, cell, or other contact options, and provide the best contact numbers in the spaces provided.
5. Choose whether you permit relevant medical information to be left on your voicemail by selecting either 'I DO' or 'I DO NOT'.
6. Decide if you want relevant information shared with a person who answers the phone by selecting the appropriate box.
7. Review the Notice of Privacy Practices acknowledgment box to confirm your understanding of how your information will be handled.
8. Familiarize yourself with the policies regarding appointments and referrals to ensure compliance.
9. Read through the self-pay and insurance policy information to understand your financial responsibilities.
10. After filling in all sections, sign the form, provide the date, and print your name as required.
11. Finally, save any changes, download, or print the form for your records.

Complete your PATIENT PRIVACY CONSENT FORM I online to ensure your privacy and proper care.