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A group visit is a shared medical appointment where several patients, family, and friends meet with one provider at the same time.
During a group visit, some of your health information will no longer be private.
For example, at a group visit for diabetes others ar elikely to believe that you might have diabetes because you are in a diabetes group visit.

If you have medical concerns that you do not whant others to know about, you should discuss them with your doctor in a one-on-one appointment.
    •    Group visits are not private. Conversations about your health or your health care during your group visits
          are not private.
    •    You authorize discussion of your personal health information in a group setting.
    •    You may have a one-on-one appointment with your provider. You are not required to participate in a group visit.
    •    You voluntarily wish to participate in a group visit.
    •    You will respect the privacy of others in the group and will not talk about anyone else's health information
          after the group visit is over.
    •    You will not hold Boice-Willis Clinic, PA, its employees , or officers responsible for any breach of confidentiality
          committed by other participants in this group.
    •    Video or audio during group visits are not allowed.
    •    You are not required to sign this form to receive medical treatment.

By signing this document, you agree that you have read and understand the statements listed above.

Click to download: Notice of Privacy Practices (Revised 6/2018)
*  By checking this box, I agree that my typed name will be considered the equivalent of my inked signature and I have downloaded a copy of the Notice of Privacy Practices.
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