NOTICE OF PAYMENT POLICY AND PROCEDURES
CREDIT CARD AUTHORIZATION FORM
INFORMATIONAL FORMS
INFORMED CONSENT REGARDING ELECTRONIC COMMUNICATION
GUIDELINES FOR INCLEMENT OR WINTER WEATHER
PROTECTED HEALTH INFORMATION AND HIPAA - YOUR RIGHTS AND OUR RESPONSIBILITIES
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides consumers with important privacy rights and protections with respect to their health information, including important controls over how their health information is used and disclosed by health plans and health care providers. Ensuring strong privacy protections is critical to maintaining individuals’ trust in their health care providers and willingness to obtain needed health care services, and these protections are especially important where very sensitive information is concerned, such as mental health information.
For more information about your rights and our responsibilities, visit the U.S. Department of Health and Human Services - HIPAA Privacy Rule and Information Pertaining to Mental Health
GIL INSTITUTE NOTICE OF PRIVACY PRACTICES RELATED TO PROTECTED HEALTH INFORMATION (PHI)
CLIENT ACKNOWLEDGEMENT OF RECEIPT AND REVIEW OF PRIVACY RIGHTS