PATIENT INQUIRIES

Do you have a question regarding a Patient Statement that you've received? Enter your contact information and detailed question below.

*By filling out boxes below, patient acknowledges that Instant Transmission Medical Billing Services is not responsible for a disclosure of Protected Health Information while in transmission to the patient based on the patient's access request to receive the PHI in an unsecure manner (e-mail). This includes breach notification obligations and liability for disclosures that occur in transit when fulfilling an individual's request under HIPAA regulation  45 CFR 164.524.
FULL NAME
YOUR MESSAGE
EMAIL
PHONE
CLINIC / PROVIDER SEEN
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