HIPAA Notice of Privacy Practices
Effective Date: January, 22, 2026
This Notice describes how medical information about you may be used and disclosed and how you can access this information.
Our Responsibilities
[Practice Name] is required by law to maintain the privacy and security of your Protected Health Information (PHI). We will not use or share your information other than as described in this Notice unless you tell us we can in writing.
How We May Use and Disclose PHI
We may use and disclose your PHI for treatment, payment, and healthcare operations, including coordination of care, billing, and quality improvement activities, as permitted by law.
Your Rights
You have the right to:
Access and obtain a copy of your medical records
Request corrections to your medical information
Request restrictions on certain uses or disclosures
Receive a list of disclosures where required by law
Our Duties
We will notify you if a breach occurs that may have compromised the privacy or security of your information.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the practice or with the U.S. Department of Health and Human Services. Filing a complaint will not affect your care.
Contact Information
If you have questions about this Notice or wish to file a complaint, please contact us through the website contact form.