Provider Directory - Welcome to Mon Health

Sarah Highlander, CNM Mon Health Obstetrics and Gynecology 1703 Locust Ave. Fairmont WV 26554 Phone: (304) 366-6100 Fax: (304) 366-2220 Hopwood (Gynecology Only) John Sunyecz, MD Christine Wilson, MD Women First Obstetrics & Gynecology Lisa Brodak, NPEmily J Courtwright, PA-C 1142 National Pike Hopwood, PA 15445 Phone: (724) 437-2147 Kingwood

  Highlander

Provider Directory

• Oculofacial Surgery • Ophthalmology • Oral and Maxillofacial Surgery •Orthopedics & Sports Medicine • Pain Management • Plastic Surgery • Podiatry • Psychiatric Care • Pulmonary Rehabilitation • Pulmonology • Radiation Oncology • Radiology • Rheumatology • Robotic Surgery • Sleep Medicine • Telehealth ...

  Surgery, Robotic, Robotic surgery

Provider Directory

4 5 Addiction Medicine Bruce Gorby, DO Paul Alappat, MD Lively Healthcare Center 533 Hackers Creek Rd. Jane Lew, WV 26378 Phone: (304) 884-8941 Fax: (304) 884-8943

Provider Directory

St. George Medical Clinic Krishna Bingi, MD 8591 Holly Meadows Road Parsons, WV 26287 Phone: (304) 478-3339 Fax: (304) 478-3311 Weston Wissam Gharib, MD Salaam Sbaity, MD Bradford Warden, MD Stephanie Barker, FNP 66 Hospital Plaza Weston, WV 26452 Phone: (304) 269-6004 Fax: (304) 269-6026 Abdulmalek Sabbagh, MD Ebrahim Sabbagh, DO

  George, Weston

Patient Authorization to Disclose, Release and/or Obtain ...

Patient Authorization to Disclose, Release or Obtain Protected Health Information. Item #1 (Patient Information): The name, birthdate, phone number and Medical Record Number (if known) of the patient. Item #2 (Purpose): indicate any and all purposes for disclosure.

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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH …

of protected health information. Covered entities as that term is defined by HIPAA and Texas Health & Safety Code § 181.001 must obtain a signed authorization from the individual or the individual’s legally authorized representative to electronically disclose that indi-vidual’s protected health information. Authorization is not required for

  Health, Information, Authorization, Protected, Disclose, Bonita, Authorization to disclose protected health, Protected health information

Authorization for Disclosure of Consumer Med/Health Info

authorization, i am allowing the release of any and all of my medical/health information whether past, present or created in the future up to the expiration or revocation date of this authorization, unless otherwise indicated. the protected health information (phi) in my medical

  Health, Information, Release, Authorization, Protected, Health information, Protected health information

Authorization to Use or Disclose Protected Health …

Therefore, I release Lifespan, its employees and my physicians from all liability arising from this disclosure of my health information. 10. It is my understanding that this authorization is for information we have at the time of your request, only for the information requested above and will expire 1 year from the date signed below.

  Health, Information, Release, Authorization, Protected, Health information, Protected health

AUTHORIZATION FOR USE OR DISCLOSURE OF PATIENT …

Your cancellation will not affect information that was released prior to receipt of the written request. REDISCLOSURE: Once this information is released, it may not be protected under federal privacy law (HIPAA). State or other federal law may require the recipient to obtain your authorization before further disclosure.

  Information, Authorization, Protected, Bonita

(Sample) Standard Authorization For Disclosure Of Mental …

authorization may be redisclosed by the recipient and the protected health information will no longer be protected by the HIPAA privacy regulations, unless a State law applies that is more strict than HIPAA and provides additional privacy protections. I will be given a copy of this authorization for my records.

  Health, Information, Standards, Samples, Authorization, Protected, Mental, Disclosures, Protected health information, Standard authorization for disclosure of mental