NOTICE OF PRIVACY PRACTICES

Effective Date of this Notice: April 1, 2003 As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)


THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU AS A PATIENT, MAY BE USED AND DISCLOSED, AND HOW YOU MAY ACCESS YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI).


PLEASE READ THIS NOTICE CAREFULLY.


OUR PRACTICE’S COMMITMENT TO YOUR PRIVACY


Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI.


We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your IIHI
• Your privacy rights in your IIHI
• Our obligations concerning the use and disclosure of your IIHI

Our notice of Privacy Practices provides information about how we may use and disclose protected health information about you, our patient. The Notice contains a Patient Rights section describing your rights under the law. You have the right to review and receive a copy of this Notice. The terms of our notice may change. If we change our Notice, you may obtain a revised copy by contacting our office.


The Practice, with my consent, may use and disclose protected health information (PHI) about me to carry out treatment, payment and healthcare operations (TPO).


The Practice, with my consent, may call my home or other designated location and leave a message on voice mail or in person in reference to any items that assist the Practice in carrying out TPO, such as appointment reminders, insurance items and any call pertaining to my clinical care, including laboratory results among others.


The Practice, with my consent, may mail to my home or other designated location any items that assist the Practice in carrying out TPO, such as appointment reminder cards, patient statements and advertisements for our services.


I have the right to request that the Practice restrict how it uses or discloses my PHI to carry out TPO. However, the Practice is not required to agree to my requested restrictions, but if it does, it is bound by the agreement.