410-280-9500 afm@annapolisfamilymedicine.org

 Annapolis Family Medicine

William Dabbs, M.D.│ Kastle Donovan, C.R.N.P. │ Amy Ricker, C.R.N.P.│Catherine Wilson C. R.N.P │ Eileen Delaney, C.R.N.P.

I
Patient Name (please print) hereby acknowledge receipt of the AFM HIPAA Policy given to me.

PATIENT HIPAA COMMUNICATION

It is the policy of Annapolis Family Medicine not to release confidential medical information regarding your treatment to family members or friends, except for (i) parent/legal guardian, (ii) other persons authorized by the patient, (ili) as we may reasonably infer from the circumstances (for example, if you bring a family member or friend into the exam room, we will assume, unless you object, that the person is entitled to receive information regarding your treatment), (iv) in emergency situations, or (v) as otherwise permitted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you anticipate that you will need or want your medical information to be provided to family members, friends, or caregivers, please indicate that below, so that we may best serve you. By signing below, you authorize the following persons to receive information, as requested, regarding your care and treatment. Updates to this form must be made in person.
MISSION

The mission of Annapolis Family Medicine is to promote the health and well-being of the community’s needs by providing accessible high-quality medical care for people of all ages.

OUR LOCATION

Annapolis Family Medicine
104 Ridgely Ave, Ste 302
Annapolis, MD 21401

T: 410-280-9500
F: 443-214-5168

All office visits are by appointment only

OUR HOURS

Business Hours

Monday: 8:00AM - 5:00PM

Tuesday: 8:00AM - 12:00PM, 1:00PM - 5:00PM

Wednesday: 8:00AM - 5:00PM

Thursday: 8:00AM - 5:00PM

Friday: 8:00AM - 4:00PM

Lab Hours

Monday- Friday 8:00 AM-12:00 PM &1:00 PM-4:00 PM

All urgent calls during closed office hours can be directed to the Hospital Operator and the on-call provider can be called. If the phones are not working, you can call the Hospital Operator at 443-481-1000 and they will page your on-call provider.

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