When you visit the medical practice of Dr. Gary Bucher (Bucher Medical Services S.C.) it is very important that you feel safe in telling Dr. Bucher your personal information that may be required to fully diagnose or treat a problem. As medical professionals, please be assured that our practice has strict policies and procedures to protect the confidentiality of the information that you have entrusted to us. However, on April 14, 2003, new regulations became effective under a federal law called the Health Insurance Portability and Accountability Act (“HIPAA”).

HIPAA was updated on September 01, 2013. HIPAA regulations cover physicians and all other health care providers, health insurance companies and their claims processing staffs. In general, HIPAA was enacted to establish national standards to:

Give patients more control over their health information;

Set boundaries for the use and release of health records;

Hold violators accountable, with civil & criminal penalties; and

Try to balance the need for individual privacy with requirement for public responsibility that requires disclosures to protect the public health.

The HIPAA rules require that our practice makes available a copy of the “Notice of Privacy Practices”, which is available/displayed in the reception/waiting room area. The Notice describes how the medical information we receive from you maybe used or disclosed by our practice and your rights related to your access to this information.

Please sign below that we have provided you with a copy of that Notice for your review. You are entitled to a personal copy of that Notice at any time to review and keep for your records. If you have any questions about our Privacy Practices, please feel free to contact our Privacy Officer.

Thank you for your cooperation.

I acknowledge that I have received a copy of Bucher Medical Services, S.C. Notice of Privacy Practices and have been given an opportunity to ask questions.