Effective date: 16 March 2010
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 care and service you received from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice apply to all 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 in ways in which we may use and disclose health information about you. We also describe your rights to 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:
• Make sure that health information that indemnifies you is kept in private.
• Give you this notice of our legal duties and privacy practice with respect to health information about you.
• Follow the terms of Notices that is currently in effect.
How we may use and disclose health information about you:
• For treatment
• For payment
• For health care operation
• For appointment reminders
• As required by Law
• To avert a serious threat to health and safety
• As required by the Military or Veterans and Workers Compensation
• Public Health risks
• Health oversight activities
• Lawsuits and disputes
• Law enforcement
• Coroners, health examiner and funeral directors
• National Security and Intelligence activities
• Protective Service for the President and others
• Security officials for Inmates
Your rights regarding Health Information about you:
• Right to inspect and copy
• Right to Amend
• Right to an Accounting of Disclosure
• Right to request restriction
• Right to request Confidential Communications
• Right to a paper copy of this Notice (full Notice is available upon request)
Change to this Notice: We reserve the right to change this Notice. We will post a copy of the current notice publicly with the effective date on the first page.
Complaints: 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 us at +1 (480) 357-6275 to file a complaint.
Acknowledge: We will request that you make a statement acknowledging you have received a copy of this notice. This acknowledgement will become part of your records.