The Medical Privacy Notice Template states in easily understandable language how a patient’s information may be used. The notice must give examples of how the information may be shared, for instance, between a physician and a nurse or between a hospital and an insurer. The American Hospital Association has developed a model notice that is eight pages long, but there is no standard format.
MDO109-2 NOTICE OF PRIVACY PRACTICES describes your rights and certain obligations the medical practice has regarding the use and disclosure of medical information. The law requires the practice to (1) Ensure medical information is protected; (2) Provide the patient with this Notice describing our legal duties and privacy practices with respect to medical information about him/her; (3) Follow the current terms of the Notice in effect. The practice reserves the right to change the office’s privacy practices and the Notice. They reserve the right to make the revised or changed Notice effective for medical information they already have about patients as well as any information they receive in the future. There should be a copy of the current Notice at the office.
Format: Microsoft Word 2013 (.docx)
Manual: Medical Office
Procedure: Health Insurance Portability Accountability Procedure MDO109
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