Privacy Notice

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.
Your protected health information (i.e., individually identifiable information, such as names, dates, phone/fax numbers, email addresses, home addresses, social security numbers, and demographic data) may be used or disclosed by us in one or more of the following aspects:

• To other health care providers (i.e., your primary care physician, referring – physician or other specialist etc.) in connection with our rendering treatment to you.
• To third party payors or spouses (i.e., insurance companies, employers with direct reimbursement, administrators of ?exible spending accounts, etc.) in order to obtain payment of your account (i.e., to determine benefits, dates of payment, etc.);
• Internally, to all-staff members who have any role in your treatment or billing;
• To other patients and third parties who may sec or overhear incidental disclosures about your treatment, scheduling, etc.;
• To your family and close friends involved in your treatment; and/or

We may contact you to provide appointment reminders on information about treatment alternatives or other health-related-benefits and services that may -be of interest to you.
Any other uses or disclosures of your protected health information will made only after obtaining your written authorization, which you have the right to revoke.

Under the new privacy rules, you have the right to:

• Request restrictions on the use and disclosure of your protected health information;
• Request-confidential communication of your protected health information;
• Inspect and obtain copies of your protected health information through asking us;
• Amend or modify your protected health information in certain circumstances;
• Receive an accounting of certain disclosures made by of you protected health information; and,

You may, without risk of retaliation, file a complaint to any violation by us of your privacy rights with us (by submitting inquiries to our Privacy Contact Person at our office address) or the United States Secretary of Health and Human Services (which must be held within 180 days of violation).