Privacy Notice

Privacy Policies and Authorizations 
 
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED/DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.   
 
PLEASE REVIEW IT CAREFULLY.  THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.  
 
We have always been very concerned with protecting your privacy, but now the federal and state law requires us to maintain the privacy of your health information.  We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.  This notice will remain in effect until further notice.  
 
Uses and Disclosures of Health Information We use and disclose health information about you for treatment, payment, and healthcare operations.  For example:  
 
Treatment:  We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.   
 
Payment:  We may use and disclose your health information to obtain payment for services we provide to you.  
 
Healthcare Operations:  We may use and disclose your health information within this clinic in connection with our healthcare operations.  Healthcare operations include, but are not limited to, quality assessment and improvement activities such as reviewing office procedures and training staff.  Patient information will be disclosed in hardcopy only.  No fax or internet transmissions will be sent.  
 
We may also disclose your health information with your written consent.  Your authorization may be revoked in writing at any time.  Your revocation will take effect upon receipt.  Any authorization you have signed that we receive from any other source will also be considered valid.  
 
Your Family and Persons Involved in Your Care:  We ask that patients take responsibility to make and cancel their own appointments, except in the case of minors or disadvantaged adults.  We confirm your appointment time by telephone and may leave a message on either a voicemail or with another person in your household if you are not available.  We will also use our professional judgment when allowing another person to pick up supplements or requested information relayed on your behalf.  
 
You have the right to get a copy of your health record by giving us a written request.  We reserve the right to charge for copying costs at a rate of $.90 per page and a $12.00 retrieval fee.  
 
 
You have the right to request that we do not disclose your health information to specific individuals, companies, or organizations.  If you would like to place any restrictions on the use or disclosure of your health information, please let us know in writing.  We are not required to agree to your restrictions.  However, if we agree with your restrictions, the restriction is binding on us.