1229 Silver Lane, Suite 2
McKees Rocks, PA 15136
Tel: (412) 859-3199
E-Mail: info@terrificteethpd.com

HIPAA Notice of Privacy Practices

I understand that, under the Health Insurance Portability & Account Act of 1996 (HIPAA), I have certain rights to privacy regarding my Protected Health Information (PHI). 

I understand that this information can and will be used to:

  • Conduct, plan, and direct my treatment and follow-up among the multiple health care providers who may be involved in the treatment directly or indirectly
  • Obtain payment from third party payers
  • Conduct normal healthcare operations

I have read and understand that I may submit a written request how my PHI is used or disclosed to carry out treatment, payment, or healthcare operations. I also understand that you are not required to agree to my requested restrictions, but if you do agree, then you are bound to abide by them.