Patient Forms
Privacy and Release FormDownload Records Request FormDownload Notice of Privacy PracticesDownload Driving DirectionsDownload Confidential Medical History QuestionaireDownload
Read MoreHIPAA Statement
(Effective Date: April 14, 2003) As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF OTOLOGIC CENTER, INC.) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY…
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LOCAL RESOURCESMidwest Ear Institute4320 Wornall Road, Suite 420Kansas City, MO 64111(816) 932-1660 (Phone)(816) 932-1675 (Fax)(Local Affiliates of SHHH [www.shhh.org – National Website] in the Greater KC Area)Greater Kansas City ChapterSherry Cox—Contact Person18207 E. 27th TerraceIndependence, MO 64057Johnson County GroupLeonard Hall—Contact Person14646 Kaw DriveOlathe, KS 66062Hartley Family CenterKU Medical CenterHearing and Speech3901 RainbowKansas City, KS 66160(913) 588-5750Children’s TLC3101 Main…
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