This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
1Our Pledge Regarding Your Medical Information
We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements.
This notice will tell you about the ways we may use and share your medical information. It also describes your rights and certain duties we have regarding the use and disclosure of medical information.
2How We May Use and Disclose Your Medical Information
Treatment: We may use your medical information to provide you with medical treatment or services. We may disclose your medical information to doctors, nurses, technicians, or other personnel who are involved in your care.
Payment: We may use and disclose your medical information to bill and collect payment for the services we provided to you. For example, we may need to give your health plan information about your treatment so your health plan will pay us or reimburse you for the treatment.
Healthcare Operations: We may use and disclose your medical information for healthcare operations purposes. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care.
3Your Rights Regarding Your Medical Information
Right to Inspect and Copy: You have the right to inspect and copy your medical information that may be used to make decisions about your care.
Right to Amend: If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
Right to an Accounting of Disclosures: You have the right to request a list of the disclosures we made of your medical information.
Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
4Our Duties
We are required by law to maintain the privacy of your medical information and to provide you with this notice of our legal duties and privacy practices with respect to your medical information.
We are required to abide by the terms of this notice currently in effect.
We reserve the right to change our practices and to make the new provisions effective for all information we maintain. If we make a material change to this notice, we will provide you with a copy of the revised notice.
5Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
Contact Information
If you have questions about this notice or any of the information on this page, our team is happy to help.
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Need Clarification?
If you have questions about this notice, our team is happy to help.