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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.

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.