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This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully

We use health information about you for treatment, to obtain payment for treatment, administrative purposes, and to elevate the quality of care you receive. Continuity of care is part of treatment and your records may be shared with other providers to whom you are referred. Information may be shared by paper mail, electronic mail, text messaging, fax or other methods.

We may use or disclose identifiable health information about you without your authorization for several reasons. Subject to certain requirements, for auditing purposes, for research studies, and for emergencies. We provide information when otherwise required by law, such as for the law enforcement in specific circumstances. In any other situation we will ask you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any further uses and disclosure.

We may change our policies at any time before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area. You can request a copy

Individual Rights In most cases you have the right to look or get a copy of health information about you that was used to make decisions about you. If you request copies we will charge you only normal photocopy fees ($0.60 per sheet), available in 2 weeks from date of request. You may also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment or related administrative purposes and other than when you explicitly authorized it. If you believe that information in your record is incorrect or if important is missing, you have the right to request that we correct the existing information or add the missing.

Complaints If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact our office. You may also send a written complaint to the U.S. Department of Health and Human Service.

Our Legal Duty We are required by law to protect privacy of your information provide this notice about our information practices, follow the information practices described in this notice, and obtain your acknowledgement to receipt of this notice.

I CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT AND ACCURATE.