The Practice is required to abide by the terms of this notice. The Practice may change the terms of this notice, at any time. Any new Notice the Practice issues will be effective for all PHI that the Practice maintains at that time. You may receive a revised copy by calling our office.

Your PHI may be used and disclosed by the Practice’s medical staff and office staff as well as others outside of the Practice that are involved in your care and treatment for the purpose of treatment, payment or healthcare operation.

1. Treatment uses include the coordination and management of your healthcare or disclosure of your PHI to healthcare providers and/or a laboratory for testing that may be involved in your treatment.

2. Payment uses include activities needed to obtain payment for healthcare services the Practice provides to you such as: your health insurance plan determining eligibility or coverage for insurance benefits or reviewing services provided to you for medical necessity.

3. Healthcare operation uses include activities to support the practice’s business activities, quality assessment activities and employee review activities.

4. In addition, the Practice may contact you to provide appointment reminders, share your information with third party “business associates” that perform activities for the Practice and to contact you to provide you with information about treatment alternatives or other health related services that may be of interest to you.

Other uses and disclosures of your PHI will be made only with your written authorization, unless permitted/required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

The Practice may use and disclosure your PHI in some instances to a third party involved with your healthcare, for example, a relative of close friend. You have the opportunity to agree or object to the use or disclosure of the PHI to the third party. If you are not present or able to agree or object to the disclosure of the PHI to the third party, then we may use professional judgment to determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your healthcare will be disclosed to the third party. In an emergency treatment situation, we may use or disclose your PHI without your authorization.

We may use or disclose your PHI in the following situations without your authorization: where required by law, for public health purposes, in connection with legal proceedings, and in connection with workers’ compensation cases.

You have the following rights regarding medical information we maintain about you:

1. Right to Inspect and Copy your PHI

You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes medical and billing records and any other records that the Practice uses for making decisions about you. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Under federal law, we may deny your request to inspect or copy information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. We may also deny your request to inspect and copy for certain other lawful reasons. If you are denied access to medical information, you may request that the denialbe reviewed depending on the circumstances.

2. Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. In certain cases, we may deny your request for an amendment.

3. Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you after October 28, 2003. This right applies to disclosures for purposes other than: disclosures made pursuant to an authorization signed by you or disclosures for treatment, payment or the Practice’s healthcare operations as described in this notice.

4. 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 health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request

5. 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. We may condition accommodation of such request by asking for information as to how payment will be handled or specification of an alternative address or other method of contact.

6. Right to a Paper Copy of This Notice, upon Request

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.