This notice explains how your medical information may be used and disclosed, as well as how you can access it. Please read it carefully.

Your Protected Health Information

Federal law ensures the confidentiality of your health information. This includes details about your symptoms, test results, diagnoses, treatments, billing, and insurance.

How We Use Your Health Information

Your health information is used for your treatment, to process payments, and for operational purposes, such as administrative tasks and assessing the quality of care provided. In some cases, we may be required to share this information without your permission.

Examples of Use and Disclosure

• Treatment: Health information may be shared among doctors, nurses, and other providers involved in your care. For example, we may provide information to another physician or pharmacist as part of your treatment.
• Payment: Your health information may be disclosed to process payments, including obtaining insurance authorizations or submitting bills for services.
• Healthcare Operations: We use your information for standard operations, such as managing records, evaluating treatment quality, and monitoring outcomes.

Special Uses

We may contact you for appointment reminders or to inform you about treatment options or services that might interest you.

Other Uses and Disclosures

In certain situations, your information may be shared without your explicit permission:

• Legal Requirements: Reporting incidents such as gunshot wounds, abuse, or neglect.
• Research: For approved studies under specific conditions.
• Public Health Activities: Reporting vital statistics, disease outbreaks, or product recalls.
• Oversight: Assisting with audits or investigations related to government programs.
• Legal Proceedings: Responding to subpoenas or court orders.
• Law Enforcement: Sharing information under specific conditions.
• Workers’ Compensation: Providing information for claims related to work-related injuries or illnesses.
• Military or Government Requests: Complying with requests from military or national security authorities.
• Death Reporting: Providing necessary details to coroners, medical examiners, funeral directors, or organ donation organizations.
• Serious Threats: Disclosing information to prevent significant harm to health, safety, or public welfare.

Your Rights

You have the following rights regarding your health information:

1. Request Restrictions: You may ask to limit the use or sharing of your information, though we are not required to comply with all requests.
2. Confidential Communications: You can request that we communicate with you through specific means or at specific locations.
3. Access to Information: You may inspect or request copies of your health information in most cases.
4. Amendments: You may ask to correct or update your records if they are incorrect or incomplete.
5. Disclosure Accounting: You can request a list of instances where your information was shared for reasons other than treatment, payment, or operations.

Our Responsibilities

We are committed to protecting your health information and adhering to the terms outlined in this notice.

Changes to This Notice

We may revise our privacy practices and update this notice accordingly. Updated notices will be available in our office, and you may request a copy at any time.

Filing Complaints

If you believe your privacy rights have been violated or you disagree with a decision regarding your health information, please contact the Administrator at XXX-XXX-XXXX. Complaints may also be directed to the U.S. Department of Health and Human Services. You will not face penalties for filing a complaint.

Effective Date

This notice is effective as of November 20, 2024, and remains in effect until further updates.

For additional information or questions, contact the Administrator at XXX-XXX_XXXX.