Legal Disclaimer

The Health Insurance Portability and Accountability act of 1996 (HIPAA), protects health information created or maintained by
health care providers throughout the United States. Prior to receiving care in our office, each patient shall receive and be
asked to acknowledge that they have received a Notice of Privacy Practices that explains their rights under HIPAA and our
use of their health information for treatment, payment and health care operations without further authorization.
Also as part of the HIPAA regulations, each patient has the right, with some restrictions, to:

  • Review his or her own medical record.
  • Request an amendment or correction to the medical record.
  • Add supplemental information to the record.
  • Restrict use and disclosure of your medical information.
  • Authorize formal consent before health information is released other than for treatment, payment or as part of health care operations and
  • Know who requested and received medical information for other than treatment, payment, or health care operations.

In protection of your information, Dahlias Medical Laser & Anti-Aging Center, LLC and its employees are prohibited,
with some exceptions, from releasing your health information to anyone not involved in your health care or in office operations,
including family members, unless you have provided written consent. The Authorization for Release of Information form allows
Dahlias Medical Laser & Anti-Aging Center, LLC to release your information to a particular agency or individual that you designate.

E-mail:dahliaslaser@gmail.com

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