Your privacy is important to us. None of your information will be shared with anyone but your other healthcare providers, in order to better manage your care.
If you are being seen for medical nutritional therapy, please sign one of the privacy notices you will be presented when we meet in person.
LAURIE BEEBE, MS,RD,LD
Notice of Privacy Practices for Clients
This notice describes how your health information may be used and disclosed for treatment and billing purposes. A law requires us to maintain this strict confidentiality, and to provide this information to you. Please review it carefully.
As a client of Laurie Beebe, your health information will always be kept secure and confidential. We realize your health information is personal and we protect your privacy.
The law permits us to use or disclose your health information to those involved in your treatment, such as your physician or other health care professionals.
We may share your health care information with other health care professionals involved in your care in order to better manage your treatment. This includes receiving information from your providers, as well as providing information to them
We may use or disclose your health information for payment of services
We may use or disclose your health information for normal healthcare operations, such as keeping your information on file
We may use your contact information to remind you of appointments, follow up to see how you are doing, or return calls. We may leave messages on your answering device unless you specifically request us not to
You have the right to know any time your health information has been shared, such as sending a note about our session to your doctor or nurse
You may request in writing that we do not use or share your information as described above
You have the right to see and receive a copy of your health information. Please request in writing if you want to see this information
We will disclose personal health information when required to do so by federal, state, or local law
If any of these details change you will be notified in writing.
If you need to file a complaint, you may contact the Department of Health and Human Services, 200 Independence Avenue SW, room 509F, Washington DC 20201. No retaliation will result from a complaint filed
We prefer you to call us first at (618)616-7704 if you have any issues
I have received a copy of the Notice of Privacy Practices
Print Name ____________________________________
Sign Name _______________________ date ________