HIPAA NOTICE OF PRIVACY PRACTICES
Effective date: April 14, 2003
We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by this office, whether made by your personal doctor or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
How we may use and disclose health information about you:
Your rights regarding Health Information about you:
Changes to this Notice:
We reserve the right to change this Notice. We will post a copy of the current notice in our facility with the current effective date on the first page.
If you believe that your privacy rights have been violated, you may file a complaint with us. All complaints must be in writing. Please contact the administrator at the location where you were treated to file a complaint.
Acknowledgement of Receipt of this Notice:
We will request that you sign a separate form acknowledging you have received a copy of this notice. This acknowledgement will become part of your records. Notice of Privacy Practice - Acknowledgement