Patient Information Release

Patient Information

Allied Services is committed to protecting the privacy of your health information. Under the Health Insurance Portability and Accountability of 1996 (HIPAA), we have formalized our practices related to maintaining the privacy and security of medical information. This Web site provides information on your rights as a patient of Allied Services and how to act on these rights.

Right to be informed of our privacy practices

Our practices related to protecting the privacy of your health information are described in our Notice of Privacy Practice (NOPP). The NOPP describes how we use your information to provide treatment to you, to obtain payment for that treatment and for our internal operations. You will be given a copy of the NOPP at your first visit. We will also ask you to sign an acknowledgement indicating that you have been given a copy of our NOPP. Signing the acknowledgement is not required for us to continue to protect the privacy of your health information as described in the NOPP. We ask you for your signature so that we can keep track of who has been given a copy of our NOPP.

Right to request access to your health information

You have the ability to request a copy of your health information or to allow others to have access to your health information. If you would like a copy of your health information, we have a form which you will need to fill out. If you would like some of your health records sent to someone else, for example to another physician or to your employer, you will need to complete our authorization form indicating that you agree to our releasing the information.

Patient Information Release Forms

• Authorization to Use or Disclose Health Information - Scranton
• Authorization to Use or Disclose Health Information - Wilkes-Barre
• Patient Psychological/Drug and Alcohol Authorization Form
• Patient Authorization for Release of HIV-Related Information