This medical practice collects health information about you and stores it in a chart and/or on a computer. This medical record is the property of the practice. You can request the information in the record. The law permits us to use or disclose your health information for the following purposes: treatment, payment, health care operation, appointment reminders, sign in sheet, notification and communication with your family, marketing, as required by law, public health, health oversight activities, judicial and administrative proceedings, law enforcement, coroners, organ or tissue donation, public safety, specialized government functions, worker’s compensation, and change of ownership of the practice.

This practice will not use or disclose health information that identifies you without your written authorization, which you may revoke in writing at any time.

Your Health Information Rights include the right to: request special privacy protections, request confidential communications, inspect and copy your health information, amend or supplement your health information if you believe it is incorrect or incomplete, and an accounting of disclosures. Furthermore you have the right to a paper copy of this notice, as well as a more detailed explanation of these rights, should you so desire.