NOTICE OF PRIVACY PRACTICES
Effective Date: [March 29, 2026]

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 Rights

You have the right to:

  • Get a copy of your medical record (paper or electronic)

  • Request corrections to your medical record if you believe it is incorrect or incomplete

  • Request confidential communications, such as being contacted at a specific number or address

  • Ask us to limit what we use or share, although we may not always be able to agree

  • Get a list of those with whom we’ve shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you, such as a medical power of attorney

  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way we use and share information as we:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory (if applicable)

  • Contact you for fundraising efforts (you may opt out)

Our Uses and Disclosures

We may use and share your health information in the following ways:

Treatment

We can use your health information and share it with other professionals who are treating you.

Payment

We can use and share your health information to bill and get payment from health plans or other entities.

Healthcare Operations

We can use and share your information to run our practice, improve your care, and contact you when necessary.

Required by Law

We will share information about you if state or federal laws require it.

Public Health and Safety

We may share health information for public health purposes, such as preventing disease or reporting adverse reactions.

Abuse or Neglect

We may disclose information if we believe you are a victim of abuse, neglect, or domestic violence.

Law Enforcement

We may share information with law enforcement officials as required or permitted by law.

Health Oversight Activities

We may disclose information to health oversight agencies for audits, investigations, and inspections.

Judicial and Administrative Proceedings

We may share information in response to a court or administrative order.

Research

We may use or share your information for research, subject to strict oversight.

Organ and Tissue Donation

We may share your information with organizations that handle organ procurement.

Workers’ Compensation

We may release your information for workers’ compensation claims.

Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI)

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

  • Notify you promptly if a breach occurs that may compromise your information

  • Follow the terms of this notice currently in effect

Changes to This Notice

We reserve the right to change this notice at any time. Changes will apply to all information we have about you. The updated notice will be available upon request and posted in our office and/or on our website.

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. You will not be penalized for filing a complaint.