NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATIONNOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION.
Our Facility is dedicated to protecting your Medical Information (MI) or Protected Health Information
(PHI). We are required by law to maintain the privacy of PHI and to provide you with this notice of our
legal duties and privacy practices with respect to PHI. We are required by law to abide by the terms of
this Notice, making any revision applicable to all PHI we maintain. If we revise the terms of this Notice,
we will post a revised notice at the Office and will make paper copies of this Notice of Privacy Practices.
Your PHI is available for review upon request.
HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:
We will use your protected health information (PHI) as part of rendering patient care. For example, your
PHI may be used by the health care professional treating you, by the business office to process your
payment for the services rendered and by our staff reviewing the quality and appropriateness of the care
We may also use and/or disclose your information in accordance with federal/state laws for the following:
We will not use or disclose your medical information for any other purpose without your written
authorization. Once given, you can revoke your authorization at any time.