June 28, 2015

Client Privacy

We are committed to the privacy of our clients, and we take your Personal Health Information seriously.  As a new client, we'll ask you to sign our HIPAA (Health Insurance Portability and Accountability Act) Compliance form and, if needed, a Release of Information form.

Release of Information Authorization Form

Please download the and read our Release of Information form.  If you agree and acknowledge to the contents of this form, you can complete the consent to disclose form.

HIPAA Compliance Form

Family Service Madison has provided this Notice of Privacy Practices in compliance with HIPAA laws. This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

 

You can see a more comprehensive list of new client forms by clicking here.