NOTICE OF PRIVACY PRACTICES
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.
1. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION. We use health information about you for treatment, for reimbursement of treatment, for administrative purposes, and to evaluate the quality of care that you receive. For example, your health information may be shared with other providers to whom you are referred. Information may be shared by paper, mail, electronic mail, fax, or other methods. We may use or disclose your health information without your authorization for several reasons. But beyond those situations, we will ask for your written authorization before using or disclosing your health information. If you sign an authorization to disclose information, you can later revoke it to stop any further uses or disclosures.
2. YOUR RIGHTS. In most cases, you have the right to look at or receive a copy of your health information that we use to make decisions about you. If you request copies, we may charge a cost-based fee. You also have the right to request a list of certain types of disclosures of your information that we have made. If you believe your health information is incorrect to the existing information we will ask that you provide the correct information or add the missing information.
3. OUR LEGAL DUTY. We are required by law to protect the privacy of your health information, provide this notice about our privacy practices, and follow the privacy practices that are described in this notice, and seek acknowledgement of receipt of this notice. We may change our privacy policies at any time. Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area. You can also request a copy of our new notice at any time. For more information on our privacy policies, contact the person listed below.
4. PRIVACY COMPLAINTS. If you are concerned that we have violated your privacy rights, our privacy policies, or if you disagree with a decision we made about access to your health information, you may contact the person listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you the appropriate address on request.
If you have any questions or complaints, please contact:
Privacy Officer Services
The U.S. Department of Health & Human Services