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Privacy & License Policy
If you consent, Locust Grove and Reliance Family is permitted by
federal privacy laws to make uses and disclosures of your health information for
purposes of treatment, payment and health care operations. Such information may
include documenting your symptoms, examination and test results, diagnoses,
treatment and applying for future care or treatment. It also includes billing
documents for those services.
When you come into the office, you will receive a privacy agreement that is
filled with information that explains the circumstances that we may use your
information. We do not use your information for anything other than medical
(information) or reimbursement purposes. You will also receive a paper that
instructs us on who is allowed to receive your personal medical results. |
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The Information obtained on this website is for our office use
only. Unless you have signed the privacy agreements that you receive when you
become a patient of Dr. Trivedi's your information will not leave our office.
Here is a PDF copy of the two privacy releases you sign when you
become a patient. If you'd like you are welcome to print them out and bring them
(pre-filled) to the office when you come in.
HIPAA Acknowledgement Consent Form
Patient Medical Records Release Form
If you are already a patient, unless requested you will not need
to sign these forms again. |
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