Federal and state laws require us to provide you with notice in regard to your health information. Your medical and billing records in our practice are examples of information that usually will be regarded as protected health information.

We may disclose your health information to a physician in the office, outside consultant or other health care provider.
We may use your name in our office to call you into the exam room.
We may contact you to inform you of the arrival of any products you may have ordered from our office via phone, text, email or notification letter using our practice name and address.
We may contact you to provide appointment reminders via phone, text or email using our practice name and mailed postcards using our practice name and address.
We may share your medical information with a hospital, laboratory and medical vendors.

Your healthcare may be used and disclosed by our office to obtain payment for services rendered. This information may be shared with the primary insured on your plan or any family member designated as your responsible party.
We may mail or email you bills with our practice name and address when necessary.
We may provide information to collection agencies or attorneys for acquiring delinquent payments.

If law requires our office to disclose your protected health information, our office will comply. We will disclose protected health information for military or veteran activities, national security, correctional institutions and law enforcement officials. Our office will notify appropriate authorities if we have reason to believe that you have been a victim of abuse, neglect or domestic violence.

In addition to the above uses of your protected health information, you have the right to give us written notice to not use or disclose your health information to anyone for any reason. We will use or disclose only the protected health information that is deemed necessary in our professional judgement and experience to make reasonable recommendations.

You have the right to request that we amend protected health information that we maintain about you in our designated records if the information is inaccurate or incomplete. This right is subject to limitations. Our office reserves the right to change the notice at any time.

If you believe that we have violated your privacy, you may submit a written complaint to our practice or to the Secretary of Health and Human Services.

This form is in compliance with the Health Insurance Portability & Accountability Act (HIPAA). If there are any questions or concerns you have regarding this notice, please inform us. Our office is committed to protecting your health information.