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Important Notice Regarding Protected Health Information (PHI)
ChiroEdge is committed to maintaining compliance with HIPAA regulations and protecting the privacy and security of protected health information (PHI). If you are not a ChiroEdge client, please be aware that entering any PHI into this form without an executed Business Associate Agreement (BAA) between your organization and ChiroEdge constitutes a breach of HIPAA regulations.
By proceeding to use this form, you acknowledge and agree that:
You are solely responsible for any unauthorized disclosure of PHI that may result from improper use of this form.
ChiroEdge will not be held liable for any HIPAA violations caused by users who submit PHI without the necessary agreements in place.
If you are interested in becoming a ChiroEdge client or require a BAA to ensure HIPAA compliance, please contact us at [insert contact information or link to inquiry page].
Thank you for your attention to this critical matter.