THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THISS INFORMATION. PLEASE REVIEW IT CAREFULLY. This notice is provided in two layers: This top layer briefly summarizes how we handle your health information, and the bottom layer provides further details of our privacy policies and procedures.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION. We use health information about you for treatment, for administrative purposes, and to evaluate the quality of care that you receive. For example, your health information may be shared with other providers to whom you are referred. Information may be shared by paper, mail, electronic mail, fax, or other methods. We may use or disclose information without your authorization for several reasons. But beyond those situations, we will ask for your written authorization before using or disclosing your health information. If you sign an authorization to disclose information, you can later revoke it to stop any future uses or disclosures.
YOUR RIGHTS. In most cases, you have a right to look at or obtain a copy of your health information that we use to make decisions regarding your care. If you request copies, we may charge you a cost-based fee. You also have the right to request a list of certain types of disclosures of your information that we have made. If you believe that your health information is incorrect or that information is missing, you have a right to request that we amend the existing information or add the missing information.
OUR LEGAL DUTY. We are required by law to protect the privacy of your health information, provide this notice about our privacy practices, follow the privacy practices that are described in this notice, and to seek your acknowledgement of receipt of this notice. We may change our privacy policies at any time. Before we make a significant change in our privacy policies, we will change our notice and post the new notice in the waiting area. You can also request a copy of our privacy notice at any time. For more information about our privacy policies, please contact the person listed below.
PRIVACY COMPLIANTS. If you are concerned that we have violated your privacy rights, our privacy policies, or if you disagree with a decision we made about access to your health information, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.
If you have any questions or complaints, please contact the administrator at