The following consent form allows the doctors and staff members of Mathur Spine Surgery and Cary Orthopaedic Spine specialists to use and disclose information about you, the patient, that is protected under the Health Insurance Portability and Accountability Act of 1996.
The information that you disclose can be used to carry out payment, treatment, or health care operations. Mathur Spine Surgery and Cary Orthopaedic Spine has or will provide you with a Notice of Privacy Practices, which gives a more comprehensive overview of such uses and disclosures.
By filling out the form below, you agree that you understand the terms of the Notice of Privacy Practices, that these terms may change, and that you authorize Mathur Spine Surgery and Cary Orthopaedic Spine specialists to disclose your health information for the aforementioned purposes.