Patient forms and information

7.20 - Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.

7.32 - Patient Authorization for Disclosure to Designated Provider

Purpose of request - I request and authorize the disclosure or release of my protected health information

7.40 - Patient Privacy Complaint Form

This form is provided so that we may address your concerns with the privacy policies and procedures of our practice.

7.60 - Request for Access to Protected Health Information

Under the Privacy Rule, a patient or their personal representative may request access to the patient’s protected health information for the purposes of inspection and/or obtaining a copy of the protected health information.

7.70 - Patient Request for Restriction of Protected Health Information

Requesting a restriction on the use and/or disclosure of my protected health information.

7.80 - Patient Request for Amendment of Protected Health Information

Requesting an amendment to my protected health information maintained by Mid-Michigan Physicians, P.C.

7.90 - Disclosure Accountability Request

Requesting a list of disclosures of my protected health information during a specific date

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Patient Notice Know Your Benefits

Please be advised that due to the many hundreds of insurance plans available and the frequent plan changes, we cannot be informed regarding the covered benefits of each patient.

Patient Notice Know Your Benefits Imaging Center

Please be advised that due to the many hundreds of insurance plans available and the frequent plan changes, we cannot be informed regarding the covered benefits of each patient.

Preventive Care Scheduling Information

What you should know about scheduling your preventive care appointment.