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HIPAA Privacy Acknowledgment

Please review our privacy practices and sign below to acknowledge receipt.

Patient Information

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Notice of Privacy Practices

Michael E. Buxbaum, D.O., P.A. ("Buxbaum Medical") is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of our legal duties and privacy practices with respect to your PHI.

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

We may use and disclose your PHI for treatment, payment, and healthcare operations.
You have the right to request restrictions on certain uses and disclosures of your PHI.
You have the right to revoke any authorization you provide, in writing, at any time.
We reserve the right to change our privacy practices and to make new provisions effective for all PHI we maintain.
You may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.

I acknowledge that I have been provided with or offered a copy of the Notice of Privacy Practices for Michael E. Buxbaum, D.O., P.A. I have had the opportunity to review this notice.

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Date: 3/25/2026