Permission Granted?

Image result for signed document

For decades, I have found myself at appointments for doctors, dentists, etc. all presenting me with pages of forms requesting a plethora of information.  They want my name, my next of kin’s name, my neighbor or close friend’s name (everything but my shoe size).  The finale of this effort is the presentation of the “confidentiality agreement”.  Typically, this document states that I am acknowledging that this establishment or anyone representing it cannot share my confidential information with ANYONE without my consent.  I am then expected to sign this document verifying that I have been told this and return it to them prior to being treated.  My question with this has always been, “If you are promising me that you will not reveal any of my confidential information, shouldn’t you be signing a document and giving it to me?”

Skip ahead to today’s pre-registration for tomorrow’s appointment.  I have been sent this document to review and sign:

Consent for Use and Disclosure of Health Information

1.    This is to inform you that XXXXXXXXX may use and disclose your health information that identifies you, and that consists of your past, present or future physical or mental health or condition, the provision of your healthcare; and the past, present or future payment for the provision of your healthcare (this health information is referred to herein as “Protected Health Information”).

2.    The use and disclosure of your Protected Health information will be to carry out treatment, payment and healthcare operations of XXXXXXXXXX.

3.    For a more complete description of how XXXXXXXXXX may use and disclose your Protected Health Information, please refer to the attached Notice of Privacy Practices. The terms of the Notice of Privacy Practices may change from time to time; therefore, to obtain a revised Notice of Privacy Practices, please contact: XXXXXXXX, Administrator.

4.    You have the right to request that XXXXXXXXXX be restricted from using or disclosing your Protected Health Information in carrying out Treatment, Payment or Health Care Operations; however, XXXXXXXXXX is not required to agree to your requested restrictions. If XXXXXXXXXX does agree to your requested restrictions, then it will comply with your request.

5.    You have the right to revoke this Consent. This revocation must be made in writing to XXXXXXXXXX. This revocation will be valid except to the extent that XXXXXXXXXX has taken action in reliance on this Consent.

By signing this document, you acknowledge that you have read and understand this Consent. Further, you hereby consent and authorize XXXXXXXXXX to use or disclose your Protected Health Information in conjunction with XXXXXXXXXX Treatment, Payment or Healthcare Operations in accordance with the terms of this Consent.

Further, I hereby authorize and give my consent to XXXXXXXXXX to communicate any of my Protected Health Information to the individuals stated in my previous release of information answers.

  1. There is no attached privacy practices document for me to review.
  2. (In Itallics….they are stating in writing that they are not required to agree with my request to restrict my information.


Why not say that?


The Roaring Ellie

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  1. Terena Anders on March 13, 2019 at 4:35 pm

    Awesome analogy! I agree 100%

  2. James Wiltsee on March 13, 2019 at 10:04 pm

    Hi roaringellie,
    An self made assignment could not be any more thorough.
    Jim Wiltsee