text: Lawrence Osman MD, PC will use your medical information for the following: TREATMENT: Including providing your medical records to consulting clinicians and insurance companies. PAYMENT: Insurance companies may request part or all of your medical records to pay the claim. HEALTH CARE OPERATIONS: Any others involved in your healthcare. The Private Policy Notices of Lawrence Osman MD, PC is posted in the waiting room for your perusal. If you would like to obtain a copy, please ask the front office, and we will gladly provide one.
  I understand and agree that, regardless of my insurance status, I am ultimately responsible for the balance of my account for any professional services rendered. I certify this information is true and correct. I will notify you of any change in the status of the above information.