To view or print a copy about privacy practices, please click on the following link: Notice of Privacy Practice.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Questions about this form should be directed to HMCCT at (503) 922.3316 or jenjee@drjenjees.com.

This form is from: http://www.hhs.gov/ocr/privacy/hipaa/modelnotices.html