This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and contra your PHI. “Protected Health Information” is information about you, including demographic information that may identify you and that relates t( your past, present or future physical health condition and related health care services. Please review it carefully.
This section explains your rights and how we are required to acknowledge them.
Request a copy of your paper or electronic medical record
Receive a paper copy of this Notice of Privacy Practices
Request correction of your medical record
Request confidential or alternative communication
Ask us to limit the information we share
Receive a list of those with whom we’ve shared your information
Right to Receive Notice of a Breach
File a complaint if you believe your privacy rights have been violated
This section addresses your choices regarding health information we may share.
You have the choice to tell us to:
We will never share your information in these cases without permission:
This section lists ways in which we may use your information and disclose it.
Public Health and Safety Issues
Compliance with the law
Changes to the Terms of this Notice
Notice of Privacy Practices Acknowledgement & Authorization Form