Continuing his Vision
Merrill P. Spencer, M.D. (1922-2006)		 icavllogo


Home About Us Services Locations Research PFO Testing Top Stories Patient Forms


  PRINT


Summary of Patient Privacy Rights

 We may share your health information to:
  • Treat you
  • Send results to your referring physician
  • Receive Payment
  • Tell family and friends about your results, per your request
  • Do anonymous research on results of tests
We may use your health information for:
  • Research reasons
You have the right to:
  • Get a copy of your medical report
  • Change your medical record if you think it's wrong
  • Get a list of with whom we share your health information
  • Ask us to limit the information we share
  • Ask for a copy of our privacy notice
  • Complain in writing if you believe your privacy rights have been violated

Acknowledgement of Spencer Vascular Diagnostic Service's Privacy Policy
(Posted in waiting room)

I also give permission to the following people to have access to my medical information:
Name: Relation: DOB:
Name: Relation: DOB:
Dr.: Phone: FAX:
Dr.: Phone: FAX:


I hereby acknowledge that I have access to Spencer Vascular Diagnostic Service's Privacy Notice.


SIGNATURE

DATE



  PRINT




Our hours of operation for outpatient services are 8:30am to 5pm, Monday-Friday (except Holidays).
To schedule an exam, please call one of our locations below. To print out our referral form, please click on the link above.
Spencer Vascular accepts all patients and most insurance plans, including Medicare & Medicaid.

Swedish Hospital / Cherry Hill Campus
Jefferson Medical Tower
1600 E. Jefferson Street, Suite 500
Seattle, WA 98122
Tel: 206.320.4400
Fax: 206.320.4696 		Swedish Hospital / First Hill Campus
Nordstrom Medical Tower
1229 Madison Street, Suite 890
Seattle, WA 98104
Tel: 206.386.6980
Fax: 206.386.6606
(c) 2008-2010 Spencer Diagnostic Services. All rights reserved. Privacy Policy