Notice of Privacy Practices
HealthNow’s Notice of Privacy Practices describes:
- How we may use and disclose your protected health information.
- Your rights to obtain access to your protected health information.
- Our legal duties relative to your protected health information.
To save the PDF version of our Notice of Privacy Practices (200KB File size) to your computer, right-click the appropriate link below and choose “Save Target As...” (Adobe Reader™ required)
Authorization Forms
- FORM 2(A), Authorization to use or disclose protected health information
- completion of this form, in most instances, is for the release of general health information - it does not allow for the release of HIV/AIDS, Mental Health, Alcohol or Substance Abuse information.
- FORM 2(D), Authorization for Release of HIV Information - completion of this form will ONLY allow the release of HIV/AIDS information.
- FORM 2(E), Authorization for Release of Confidential Medical Records Related to Alcohol and Substance Abuse and Mental Health - completion of this form will ONLY allow the release of Mental Health, Alcohol or Substance Abuse information.
If you wish to have your general health information released to someone PLUS information regarding HIV/AIDS and/or Mental Health, Alcohol and Substance Abuse, then Form 2 (A) plus one or both of the other forms need to be completed.
Please print the appropriate form(s), complete and return to the Contact Office given below. We cannot accept the form(s) electronically, as we require your signature on the form(s).
Contact Office - Mailing Address:
Buffalo |
Privacy Department |
Albany |
Privacy Department |