Sparks Eye Care LLC
Rebecca Sparks, OD
307 W Highway 54, Suite 100
Andover, KS 67002
I understand that I have certain rights to privacy regarding my protected health information. These rights are given to me under the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
By signing the consent, I authorize you to use and disclose my protected health information to carry out:
- Treatment (including direct or indirect treatment by other healthcare providers involved in my treatment);
- Obtaining payment from third party payers (e.g., my insurance company);
- The day-to-day healthcare operations of your practice.