Notice of Privacy Practice

Summary of Notice of Privacy Practice The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires that, effective April 14, 2013,we provide you a printed copy of our Notice of Privacy Practices. For you convenience, we are providing this brief summary. A copy of our full Notice is available upon request, which we encourage you to read in it’s entirety. We are required to ask you to sign a one-time acknowledgement that you have received this summary. Your Rights as a Patient You have rights with respect to your protected health information. These are summarized below and described in detail in our full Notice of Privacy Practices. Use of Protected Health Information We are permitted to use your protected health information for treatment purposes, payment and to conduct our business and evaluate the quality and efficiency of our processes. Also, we are permitted to disclose protected health information under specific circumstances to other entities. We have put into place safeguards to protect the privacy of your health information. However, there may be incidental disclosures of limited information, such as overhearing a conversation, that occur in the course of authorized communications, routine treatment, payment, or the operation of our practice. HIPAA recognizes that such disclosures may be extremely difficult to avoid entirely, and considers them permissible. Disclosures of Protected Health Information Requiring Your Authorization For disclosures that are not related to treatment, payment or operations, we will obtain your specific written consent, except as described below. Disclosures of Protected Health Information Not Requiring Your Authorization We are required by state and federal law to make disclosures of certain protected health information without obtaining your authorization. Examples include mandated reporting of conditions affecting public health, subpoenas, and other legal requests. Restriction to Use and Disclosure You may request restrictions to the use or disclosures of your protected health information, but we are not required by HIPAA to agree to such requests. However, if we do agree, only the minimum amount of such information will be used to accomplish the intended goal. Access to Protected Health Information You may request access to or a copy of your medical records in writing. If we deny the request, we will tell you why. You may appeal this decision, which, under specified circumstances, will be reviewed by a third party not involved in the denial. Amendments to Protected Health Information You may request in writing that corrections be made to your medical records. We will either accept the amendments, and notify appropriate parties, or deny your request with an explanation. You have rights to dispute such denial and have your objections noted in you medical record. Accounting of Disclosures of Protected Health Information You may request in writing an accounting of disclosures of your protected health information. This accounting excludes disclosures made in the course of treatment, payment or operations. Complaints Related to Perceived Violation of Your Privacy Rights You may register a complaint about any of our privacy practices with our Privacy Office or with the Secretary of Health and Human Services.

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