Notice of Privacy Practices

This is only a summary of our Notice of Privacy Practices. Please review to learn how we use and disclose medical information about you and your rights concerning these uses and disclosures. You may request the full Notice of Privacy Practices for review at any time.

How We Use and Disclose Your Information

We will obtain your written authorization for any uses and disclosures of protected health information (PHI) not described in the Notice of Privacy Practices.

Treatment, Payment, and Health Care Operations. We may use your PHI to provide your medical care; to bill for our services and to collect payment from you or your insurance company; and for the general operation of our business.

Marketing and Sales of PHI. We will obtain your prior written authorization before sending you certain marketing communications. We will not sell your health information without your prior written authorization.

We may use your PHI as otherwise authorized or required by law for such purposes as:

• public health reporting and oversight activities
• judicial, administrative, or law enforcement proceedings
• complying with workers’ compensation laws
• communicating with your family or caregivers
• sending appointment reminders

You Have the Right to:

• Request certain restrictions on our use and disclosure of your PHI
• Request communications from us by specific means or locations
• Inspect and copy your medical record
• Ask us to correct the information in your medical record
• Receive an accounting of disclosures of your PHI by our practice
• Be notified in the case of a breach of unsecured PHI

Contact our Privacy Officer with any questions, comments, or to exercise any of your rights. Download and sign our consent form below to acknowledge the Notice of Privacy Practices.

HIPAA CONSENT FORM / NOTICE OF PRIVACY PRACTICES