HIPAA Notice of Privacy Practices

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.

Who Will Follow This Notice
This notice describes our practices and those of:

  • Any health care professional authorized to enter information into your medical record.

  • All employees, staff, and other personnel.

Our Responsibilities
We are required by law to:

  • Maintain the privacy of your protected health information (“PHI”).

  • Provide you with this notice of our legal duties and privacy practices.

  • Follow the terms of this notice currently in effect.

  • Notify you in the event of a breach of your PHI.

How We May Use and Disclose Your Health Information
The following categories describe different ways we may use or disclose your PHI. Not every use or disclosure will be listed, but all permitted will fall within one of these categories.

  1. For Treatment:
    We may use or disclose your PHI to provide, coordinate, or manage your healthcare. For example, information may be shared with other healthcare providers regarding your treatment.

  2. For Payment:
    We may use or disclose your information so that the services you receive may be billed and payment collected.

  3. For Health Care Operations:
    We may use or disclose your PHI to support our business activities, such as quality assessment, employee reviews, or training.

Other Uses and Disclosures Allowed Without Authorization
We may disclose your PHI as required by law, for public health purposes, to organ donation organizations, for research (under specific circumstances), to coroners or funeral directors, for workers' compensation, to law enforcement (as required), and for national security and protective services.

Other Uses and Disclosures Require Your Authorization
Other uses and disclosures of PHI not covered by this notice or by law require your written authorization. You may revoke that authorization in writing at any time.

Your Rights Regarding Your PHI
You have the following rights regarding health information we maintain about you:

  • The right to request restrictions on certain uses and disclosures.

  • The right to request confidential communications.

  • The right to inspect and get a copy of your PHI.

  • The right to request amendment if you believe the information is incorrect or incomplete.

  • The right to a list (accounting) of disclosures we have made.

  • The right to a paper copy of this notice.

How to Exercise Your Rights
To exercise any of these rights, or for more information, you may contact us.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.

Changes to This Notice
We reserve the right to change our privacy practices and this notice at any time. The new notice will be effective the date it is issued and will be available upon request and posted on our website.

This format follows key requirements outlined in the HIPAA Privacy Rule and the guidance provided by HHS. Remember to customize the contact details, effective date, and any descriptions specific to your practice or state law. For specific templates and language, the U.S. Department of Health and Human Services provides downloadable model notices, which can be found on their website.