THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY

This notice describes the privacy practices followed by our employees, staff and other office personnel in protecting your health information. The practices described in this notice will also be followed by health care providers you consult with by telephone who provide call coverage for your health care provider when he or she is not available.

Duties of the Practice

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. It will tell you about the ways in which we may use and disclose health information about you and describe your rights and our obligations regarding the use and disclosure of that information. We also are required to abide by the privacy policies and practice that are outlined in this notice.

Your Health Information

This notice applies to all of this information and records we have about your health, health status, and the health care and services you receive at this office. Our records of your care will include health information generated by this practice and may possibly include information from another associated facility.

How We May Use And Disclose Health Information About You

Treatment: Your health information may be used by staff member or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professions who may provide treatment or who may be consulted by staff members.

Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health Care Operations: Your health information may be used as necessary to support the day-to-day activities and management of our medical practice. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.

Law Enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigation and to comply with government mandated reporting.

Public Health Reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the states public health department.

Research: Your health information may be used for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the office.

Workers Compensation: Your health information may be disclosed to workers compensation or similar programs. These programs provide benefits for work-related injuries or illness

Lawsuits and Disputes: Your health information may be disclosed in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.

To Avert a Serious Threat to Health or Safety: Your health information may be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Organ and Tissue Donations: If you are an organ donor, your health information may be disclosed to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate such donation and transplantation.

Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information which occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information

Appointment Reminders: Your health information will be used by staff to contact you for the purpose of appointment reminders, scheduling, billing and referrals to outside offices or facilities.

Information about Treatments: Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.

Please let us know if you do not wish to have us contact you (by telephone and/or mail) concerning your appointment, or if you do not wish to receive communications about treatment alternatives or health-related products and services. If you notify us in writing (at the address listed below) that you do not wish to receive such communications, we will not use or disclose your information for these purposes.

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