Draft prepared for review by the business owner and an attorney. Replace this notice once approved.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our duties
We are required by law to maintain the privacy of your protected health information (PHI), to give you this notice and to follow it.
How we use your health information
- Treatment: to evaluate and provide your care, including coordination with the supervising physician.
- Payment: to verify payments for your services.
- Operations: to run our practice safely, such as quality reviews.
Your rights
You may request a copy of your records, ask for corrections, request restrictions, ask for confidential communications and receive an accounting of certain disclosures.
Questions or complaints
Contact us. You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.