Privacy Policy

NOTICE OF PRIVACY PRACTICES

Effective Date: September 2, 2025

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET

ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Pledge Regarding Your Health Information

We understand that health information about you is personal. We are committed to protecting it. We create a record of the care and services

you receive to provide quality care and comply with legal requirements. This notice applies to all records of your care generated by this practice.

How We May Use and Disclose Your Information

 For Treatment: To doctors, nurses, technicians, or other personnel involved in your care.

 For Payment: To bill and collect payment from you, an insurance company, or a third party.

 For Healthcare Operations: To run the office, ensure quality care, manage personnel and training, and for compliance

purposes.

 Appointment Reminders: To contact you regarding scheduled appointments.

 As Required by Law: When federal, state, or local law requires disclosure (e.g., abuse reporting, preventing serious threats).

 Public Health Risks: For disease prevention, reporting adverse medication reactions, and other public health activities.

 Business Associates: To service providers (billing companies, EHR vendors, insurers) who agree to maintain privacy

protections and only use information for specified purposes.

 De-identified Information: To use or disclose information with identifiers removed for research, planning, and operational

purposes.

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures not listed above require your written authorization. We will not use or disclose your information for marketing

purposes or sell your information without written permission. You may revoke authorization at any time.

Your Rights Regarding Your Health Information

 Inspect and Copy: Right to see and receive copies of your health records within 30 days.

 Amend: Right to request correction of information you believe is incorrect or incomplete.

 Accounting of Disclosures: Right to request a list of non-treatment/payment/operations disclosures.

 Request Restrictions: Right to request limits on use and disclosure (we may decline except for out-of-pocket payments).

 Confidential Communications: Right to request communication by specific method or location.

 Paper Copy: Right to receive a copy of this notice at any time.

Our Duties

We are required by law to: (1) maintain privacy and security of your protected health information; (2) provide this notice; (3) notify you

promptly of any breach that may compromise your privacy or security; and (4) abide by the terms of this notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human

Services Office for Civil Rights. You will not be penalized for filing a complaint.

Privacy Officer Contact: [Name/Title] | [Phone] | [Email] | [Office Address]