Dr. Sunny Jr
Dr. Joseph K. Sunny, Jr. MD. Gastroenterologist in Miami, Florida.
Patient Authorization
Please read to the end of the page.
Because of the changes made by Congress, we are required to get your explicit permission regarding how your medical information is handled. You may request a copy of the Notice of Privacy Practices from our staff. Please read each authorization carefully and indicate your approval by initialing on the line provided.
I authorize the release of all medical records maintained by Joseph Sunny Jr MD PLLC, which relates to services I have received from, or the results of tests ordered by Joseph Sunny Jr MD PLLC. These records may be released as needed for my care for the processing of insurance claims, to satisfy the requirements of a managed care organization of which I am a member, and/or to my attorney regarding pending or anticipated litigation under a worker’s compensation, motor vehicle accident, and/or third party liability claim.
I am giving permission for Joseph Sunny Jr MD PLLC and its sub-specialties (listed below) to obtain my prior films, scans, labs, and any records including demographic, pharmacy and medication history that may identify me and that relates to my past, present, and/or future physical or mental health or condition and related health care services . I understand that it is my responsibility to obtain previous studies, if asked to do so. If it is necessary for an employee of Joseph Sunny Jr MD PLLC to obtain my prior films, labs, and/or other records, I am giving my permission to call and/or fax on my behalf in order to get needed medical records and films.
I authorize direct payment of benefits from my insurance plan to Joseph Sunny Jr MD PLLC. I understand that I am responsible for payment of professional fees charged by Joseph Sunny Jr MD PLLC, which are not covered or not properly reimbursed under the terms of my insurance plan.
I will provide Joseph Sunny Jr MD PLLC, with the phone numbers I authorize to be used to contact me. I authorize the use of any messaging person or system, voice mail and/or answering machine to convey information regarding my care. Contact via e-mail is authorized, if I provided my e-mail address to Joseph Sunny Jr MD PLLC.
I authorize the use of fax or e-mail to send my information to myself or other parties that have a right to receive my information. I understand that every effort is made to protect my privacy, however, no absolute privacy guarantee is given when faxes or e-mails are used.
I understand that it is my right to request limited access to my records and to withdraw permission for the release of my records. I understand that this request must be in writing and that limiting or withdrawing my permission may result in the Joseph Sunny Jr MD PLLC, discontinuing its relationship with me. In that case, I will need to seek care from another source.
Self pay accepted.
Currently offering services including evaluation and management of Hepatitis C, fatty liver, abnormal liver enzymes, and celiac disease. By making an appointment, you agree to the "Patient Authorization" below. Click on Schedule at the top of the page to schedule an appointment.
Education:
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