6811 Kenilworth Ave Riverdale Park, MD 20737
301-412-1594
PATIENT INTAKE FORM
PRIVACY POLICY AND PRACTICES
As a patient of William-Micah Psychatric Clinic:
I understand I have rights to privacy of my protected health information as defined by the Health Insurance Portability Act of 1996.
I have been made aware that upon request a copy of William-Micah Psychatric Clinic's privacy policy is available to me.
William-Micah Psychatric Clinic has made me aware of their right to change the terms of its Notice of Privacy Practice.