• In order to continue to provide your pet with the quality care you have become accustomed to in our hospital, as well as operate in an efficient manner, we will need to access your pet’s health care information for the purposes of treatment, payment, and operations (such as quality assurance). In using this information this office will comply with all state and federal laws pertaining to your privacy rights, including the Privacy & Security protections provided to you by the Health Insurance Portability and Accountability Act (“HIPAA”). Specifically, we will need to disclose your private information under the following circumstances:
    • Sharing information for the purpose of treatment: We will share information with all members of your treatment team, both within this office and with other providers (personal and institutional) in order to provide your pet with quality care.
    • Sharing of information for the purpose of payment: We will share all necessary information with your insurer(s), payor(s), and their representatives.
    • Sharing information for purposes of operations: We will share information necessary for ongoing operations of this office, including (but not limited to) credentialing process, accreditation, and compliance with all federal and state laws.
    • Your consent for use and disclosure of information as described may be revoked in writing at any time. Please notify the office if you ever decide to revoke your consent.
    Your signature indicates your consent has been given freely. You understand that you may revoke this consent at any time if that revocation is in writing, but any disclosures given in reliance on this prior consent will be permissible.