Privacy Policy

This notice details how your health information may be used and disclosed, and how you may obtain access to your identifiable health information.

As a patient, we will create records regarding you and the treatment and services provided to you. Our practice is committed to maintaining the privacy of your medical records. We are required by federal law to ensure the confidentiality of your health information, and provide you with this Notice of Privacy Practices, and the policies and procedures we will maintain in our practice to secure your protected health information (PHI). We will also describe your rights and the obligations our practice has regarding the use and disclosure of medical information.

This notice pertains to all records in your PHI that are created and retained by our practice. We have the right to revise this Notice of Privacy Practices as needed.

How We May Use & Disclose Medical Information

The following details the various ways that we may use and disclose your medical information.

  • Treatment. We may use PHI to provide you with medical treatment and services. Persons working for our practice may disclose PHI in order to treat you or assist in your treatment. Additionally, we may disclose PHI to those who may assist in your care, such as your spouse, children, parent, or guardian. We may also disclose PHI with other healthcare providers for purposes related to your treatment.
  • Payment. We may use and disclose PHI so that we may bill and collect payments from your health insurance or third party payers. We may also provide PHI to third parties that may be responsible for such costs, such as family members.
  • Appointment Reminders. We may use and disclose PHI for the purposes of reminding you that you have an appointment with our practice.
  • Treatment Options. We may use and disclose PHI to inform you of potential treatment options or alternatives.
  • Release of Information to Family. We may release PHI to a family member who is involved in your medical care, or to persons helping you pay for your care.

Use & Disclosure of PHI in Certain Special Circumstances

  • Worker’s Compensation. We may release PHI to worker’s compensation programs. This information is needed to access medical disability.
  • Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law, such as for audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  • Lawsuits and Similar Proceedings. Our practice may use or disclose PHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. We will make every effort to notify you before we release this information so that you have the opportunity to legally block the disclosure.
  • Law Enforcement. We may release PHI if ordered 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 a death we believe may be the result of criminal conduct
    • Regarding criminal conduct at our offices
    • In an emergency; to report a crime, the location of the crime, or victims; or the identity, description, or location of the person who committed the crime
  • Coroners or Medical Examiners. We may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. We may also release PHI to funeral directors in the performance of their job.
  • Organ and Tissue Donations. We may release PHI to organizations that handle organs, eye, or tissue procurement or transportation, including organ donation banks, as necessary to facilitate organ or tissue donation and transportation if you are an organ donor.
  • Military. We may release PHI if you are a member of the U.S. or foreign military forces (including veterans) if required by the proper military authorities.

Your Rights Regarding Your PHI

You have the following rights regarding PHI that we maintain about you.

  • Confidential Communications. You have the right to request that our practice communicate with you in reference to your health issues in a particular manner or location.
  • Right to Request Restrictions. You have the right to request restrictions or limitations in our use of PHI for purposes of treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone else who is involved in your care.

We are not required to agree to your request. If we do agree, we are bound by our agreement not to release your information unless required by law, in the case of an emergency, or when necessary for treatment. Your request must be in writing and cover the following areas: (a) PHI you want restricted; (b) whether you are requesting the limitation of our practice’s use, disclosure, or both; (c) to whom limits you wish to apply.

  • Accounting of Disclosures. All patients have a right to request an “accounting of disclosures.” This is a list of certain non-routine disclosures that our practice has made of your PHI for non-treatment, non-payment, or non-operations purposes. Use of PHI for routine patient care is not required to be documented. This request must be in writing and cover a specific time period that may not be longer than six (6) years from the date of disclosure. Your first request within a 12-month period is free of charge. The Practice may charge for additional requests within the same 12-month period. There may be a cost for the additional request. Please contact our office regarding any costs.
  • Right to File a Complaint. If you believe that your privacy rights have been violated, you may file a complaint with our offices or with the Secretary of the Department of Health and Human Services. All complaints must be in writing. You will not be penalized for filing a complaint.
  • Changes to This Notice. We reserve the right to change this notice at any time. We reserve the right to make the revised Notice effective for PHI already obtained, as well as any information we receive in the future. A current copy of this Notice will be available in our office or may be obtained at our website at