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Privacy Policy

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As required by the Privacy Regulations created as a result of Health Insurance Portability and Accountability Act of 1996 (HIPPA).



Our practice is dedicated to maintaining the privacy of your Individually Identifiable Health Information / Medical Information. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices we have in effect at the time, and to follow the conditions of the Notice that is currently in effect.

The terms of this notice apply to all records containing your medical information that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices at any time. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past and future. You may request a copy of our most current Notice at any time. If you have any questions regarding this Notice, please contact our office manager.


The following categories describe the different ways in which we may use and disclose your medical information. Not every use or disclosure in a category is either listed or actually in place. The explanation is provided for your general information only.

  1. Medical Treatment: We may use your medical information to treat you. For example, we may ask you to have laboratory tests (such as blood, urine, skin biopsy, etc.) and we may use the results to help us reach a diagnosis. We may use your medical information in order to write a prescription for you, or we might disclose your medical information to a pharmacy when we order a prescription. Many of the people who work for our practice, including but not limited to the doctors and medical assistants, may use or disclose your medical information in order to treat you or to assist others in your treatment. Additionally, we may disclose your medical information to others who may assist in your care such as your spouse, children, parents, and/or other designated individuals. We may also disclose your medical information to other healthcare providers for purposes related to your treatment.
  2. Payment: We may use and disclose medical information about you for services and procedures so they may be billed and collected from you, an insurance company, or any other third party. For example, we may need to give your health care information about treatment you received at our Practice, to obtain payment or reimbursement for the care. We may also provide your insurance provider and/or referring physician information about a treatment you are going to receive, to obtain prior approval or determine whether your plan will cover the treatment or facilitate payment of a referring physician.
  3. Healthcare Operations: We may use and disclose medical information about you so that we can run our Practice more efficiently and to make sure that all of our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performance of our staff, deciding what additional services to offer, deciding what services are not needed, and whether certain new treatments are effective. We may disclose information to doctors, nurses, technicians, medical students and other personnel for review and learning purposes. We may also disclose information about you for internal and external utilization review and/or quality assurance to business associate for purposes of helping us to comply with our legal requirements, to auditors to verify our records, or to billing companies to aid us in this process, and the like.
  4. Appointment Reminders: We may use and disclose medical information about you to contact you and remind you of an appointment. This contact may be by phone, in writing, or may involve writing an e-mail or leaving a message on an answering machine.
  5. Health Related Benefits and Services: We may use and disclose medical information about you to inform you of health related benefits or services that may be of interest to you.
  6. Release of Information to Family/Friends: We may disclose medical information about you to a friend or family member that is involved in your care, or assists in taking care of you.
  7. Disclosures Required by Law: We will disclose medical information about you when required to do so by federal, state, or local law. Disclosure to Avert Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat either to your specific health and safety, or the health and safety of the public or another person.
  8. Public Health Risks: The law or public health authorities may require us to disclose medical information about you for public health activities. These activities generally include the following:
    • Reporting births and deaths
    • Reporting child abuse or neglect
    • Reports to prevent or control disease, injury or disability
    • Notifying a person regarding potential exposure to a communicable disease
    • Notifying a person regarding a potential risk for contracting or spreading a disease or condition
    • Notifying individuals if a product or device they may be using has been recalled
    • Reporting reactions to medications or problems with products
    • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
    • Notifying appropriate government authorities regarding the potential abuse or neglect of an adult patient, including domestic violence.
  9. Health Oversight Activities: We may disclose medical information to a local, state or federal agency for activities authorized by law. These oversight activities may include, but are not limited to, audits, investigations, inspections, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions.
  10. Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We may also use such information to defend ourselves or any member of our practice in any actual or threatened action.
  11. Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
    • In response to a court order, subpoena, warrant, summons or similar process
    • To identify or locate a suspect, fugitive, material witness, or missing person
    • About the victim of a crime, if under certain limited circumstances, we are unable to obtain the person’s agreement
    • About a death we believe may be the result of criminal conduct
    • About criminal conduct at the Practice
    • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  12. Organ and Tissue Donation: We may disclose medical information about you to organizations that handle organ, eye or tissue procurement including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation, if you are an organ donor.
  13. Coroners, Medical Examiners and Funeral Directors: We may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Practice to funeral directors as necessary to carry out their duties.
  14. Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. We will obtain your written authorization to use your medical information for research purposes.
  15. Military: We may disclose your medical information if you are a member of the U.S., or foreign military forces (including veterans) and if required by appropriate authorities.
  16. National Security: We may disclose your medical information to federal official for intelligence and national security activities authorized by law.
  17. Inmates: We may disclose your medical information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. The release would be necessary: (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
  18. Worker’s Compensation: We may disclose your medical information for workers’ compensation and similar programs

Patients Rights

This section describes your rights, and the obligations of this Practice regarding the use and disclosure of your information.

  1. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail, that we do not leave voice mail or e-mail. To request confidential communications, you must make your request in writing. We will attempt to accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.
  2. Right to Request Restrictions: You have the right to request a restriction in our use or disclosure of your health information for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree to your request, and we may not be able to comply with your request. If we do agree, we will comply with your request, except when otherwise required by law, in emergencies or when the information is necessary to treat you. In order to request restrictions, you must make your request in writing, and indicate: (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; (3) to whom you want the limits to apply.
  3. Right to Inspect and Copy: You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care, including medical and billing records, but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed. To inspect and copy your medical record, you must submit your request in writing to our office manager. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request that our Compliance Committee review the denial. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome and recommendations from that review.
  4. Right to Amend: You may ask to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the office manager. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request in writing or it does not include a reason to support the request. Also, we may deny your request if you ask us to amend information that is in our opinion (1) accurate and complete, (2) not part of the medical information kept by the practice, (3) not part of the information you would be permitted to inspect and copy, or (4) not created by our practice, unless the individual or entity that created the information is no longer available to make the amendment.
  5. Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of certain non-routine disclosures that our practice has made of your medical information for non-treatment, non-payment or non-operations purposes. Use of your medical information as part of a routine patient care in our practice is not required to be documented. For example, the doctor may share information with the medical staff; or the billing department may use your information to file your insurance claims. In order to obtain an accounting of disclosures, you must submit your request in writing to the office manager. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six years from the date of disclosure and may not include dates prior to April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the cost involved in additional requests, and you may choose to withdraw or modify your request at that time before any costs are incurred.
  6. Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the office manager. All complaints must be in writing and will be investigated, without repercussion to you. You will not be penalized for filing a complaint.
  7. Right to Provide an Authorization for Other Uses and Disclosures: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission, unless those uses can be reasonably inferred from the intended uses above. If you have provided us with your permission to use or disclose information about you, you may revoke that permission in writing at any time. If you revoke that permission, we no longer use or disclose medical information about you for the reasons covered by your written authorization. You also understand that we are unable to take back any disclosures that have already been made with your permission, and that we are required to retain our records of the care that we provide to you.
  8. Right to a Paper Copy of This Notice: You have the right to request a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.