This notice describes how your medical information may be used or disclosed and how you can gain access to it. Please read this notice carefully.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal program that requires strict confidentiality for all your personal health information. That includes all your medical and dental information used or disclosed by us in any form, whether electronic, written or verbal. The Act gives you significant rights to understand and control how your health information is used. The Act also provides penalties for the misuse of Protected Health Information (PHI).

PHI is any information about you, including demographic data that identifies you and your past, present or future health condition, as well as related healthcare services. This Privacy Policy describes how we may use or disclose your PHI to provide treatment, payment or healthcare operations or other purposes that are permitted or required by law. This policy also describes your rights to access and control your PHI.

Notice of Privacy Practices

Uses & Disclosures of Protected Health Information

Your PHI may be used or disclosed by our physicians, office staff or others involved in your care and treatment, whether providing healthcare services to you, paying your healthcare bills, supporting the operation of our practice or any other lawful use.


We will use and disclose your PHI to provide, coordinate or manage your healthcare related services. This includes the coordination or management of your healthcare by a third party. For example, your PHI may be shared with a physician if you have been referred, in order to ensure that we have the necessary information to diagnose or treat you.

Healthcare Operations

We may use or disclose your PHI to support our business activities. These activities may include quality assessment, employee review and conducting or arranging other business activities. We may call you by name in our reception area when your physician is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment or to follow-up with an appointment. Please tell us if you prefer that we call or contact you at a specific phone number or location, and if you prefer that we do/do not leave messages.

We may use or disclose your PHI under the following circumstances without your authorization. These include, as required by law:

  • Public health issues
  • Communicable diseases
  • Health oversight abuse or neglect
  • Food and Drug Administration requirements
  • Legal proceedings
  • Law enforcement
  • Coroners, funeral directors and organ donation
  • Medical research
  • Criminal activity; prison inmates
  • Military activity and national security
  • Worker’s Compensation

Required Uses and Disclosures

The law requires us to disclose to you when we are investigated by the Secretary of the Department of Health and Human Services to determine our compliance with HIPAA. Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law. You may revoke this authorization in writing at any time except to the extent that your physician or the physician’s practice has taken action in reliance to the use or disclosure indicated in your authorization.


Your PHI will be used, as needed, to obtain payment for healthcare services. For example, obtaining approval for a treatment may require that your relevant PHI be disclosed to your health insurance plan to obtain approval for a health-related procedure.

Financial Policy Agreement and Release

Your Rights

You have the right to inspect and copy your PHI. Under federal law, however, you may not inspect or copy the following records:

  • Information compiled in reasonable anticipation of, or use in civil, criminal or administrative actions or proceedings
  • PHI that is subject to law prohibiting access to said PHI

Patient Rights and Responsibilities


You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint by notifying our staff at our office and main telephone number. We will not retaliate against you for exercising your right to file a complaint. If you would like to contact the Accreditation Commission for Health Care (ACHC) regarding a complaint, you may do so by calling (855)937-2242.

Complaint Submission