THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Our office is required by law to maintain the privacy of your medical information.  Your information is used for treatment, payment, administrative operations, and when required by law for other purposes.

Treatment - We are permitted to disclose your medical information to those involved in your treatment.  For example, we may provide your referring doctor or primary care physician with information about your condition.

Payment - We will use your information to bill and collect payment for services.  For example, we may complete a claim form to obtain payment from your insurance company.

Health Care Operations - We are permitted to use your medical information for administrative purposes such as health care and legal compliance activities and for quality assurance.

Your may request that we restrict or limit how your medical information is used and disclosed for treatment, payment, or health care operations.  We do NOT have to agree to this restriction, but if we do agree, we will comply with your request except under emergency circumstances.

Other permitted uses include disclosure for:

• Public health, abuse/neglect, health oversight, legal proceedings
• Law enforcement and correctional institutions
• Worker’s compensation
• Military, national security, intelligence agencies, protection of the President
• Research, organ donation, coroners, medical examiners, funeral directors
• Food and Drug Administration (FDA)

We may contact you to provide appointment reminders, information about treatment alternatives, as part of a fund-raising effort, or other health related benefits and services that may be of interest to you.

Other uses and disclosures will be made only with your written authorization which may be revoked in writing at any time.

Although your medical record is the physical property of the physician that compiled it, you have the right to:

• Request a restriction on certain uses and disclosures of your information.  You may request that we limit disclosure to family members or close personal friends. Requests must be made in writing and state the specific restriction requested and to whom that restriction would apply.
• Obtain a paper copy of the notice of this office’s privacy practices.
• Inspect, amend, and copy your health record.  We may ask that a narrative summary be provided rather than copies.  If you do not agree, copies will be provided.  There may be a charge for paper copies. 
• Obtain an accounting of disclosures for purposes other than the permitted uses listed above.
• Receive communications of your health information by alternative means or at alternative locations.  For example, reminder notices by mail be made by sealed envelope rather than by postcard.

For requests and questions, please contact our privacy officer, indicated below.

Complaints should also be directed to our privacy officer.  You can also file a complaint with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

We are required to abide by these terms and reserve the right to change the terms of this notice.  Any changes to our notice will be posted in our facilities and will be effective immediately.  A copy of the latest version can be obtained by contacting our privacy officer.

The effective date of this notice is April 14, 2003.