Privacy Policy PDF Print E-mail

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.  We are committed to protecting the privacy of your health record and the confidentiality of your visit. Your healthcare record and the information it contains will not be disclosed to any one or any agency outside of this office without written authorization from you unless such a release is required by law.


We will use your health information for the purpose of:

Treatment: For example, information obtained by a healthcare provider or staff member will be recorded in your record and used to determine the e best course of treatment for you.

Payment: For example, a bill may be sent to you or to a third party payer. The information on the bill may include information that identifies you, as well as your diagnosis, procedure and the supplies used

Regular Healthcare Operations: For example, a member of the medical staff or the quality improvement / risk management staff may use the information in your health record to access the care you received and the outcomes of your care. 

Disclosures required by Law:

Food and Drug Administration (FDA): As required by law, we may disclose to the FDA health information relative to adverse events with respect to product defect, product recall, repairs or replacement.

Public Health: We may disclose your health information, as required by law, to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Although your record is the property of this office, the information it contains belongs to you.

You have the right to:

  • Request a restriction on certain uses and releases of your information
  • Obtain paper copy of the notice of information practices
  • Inspect a copy of your health record
  • Amend your health record as provided in 45 CFR 164.528

Our Responsibility:

  • Maintain the privacy of your health information
  • Provide you with a notice as to our legal duties and privacy practices with respect to information
  • Abide by the terms of this notice
  • Notify you if unable to agree to a requested restriction


For More Information or to Report a Problem If you have questions, or if you want to report a problem, please contact our office.

Complaints may also be filed with the United States Secretary of Health and Human Services, an act for which no retaliation will occur.  

We will hold your record to the highest standard of privacy and confidentiality, and will only release personal health information when authorized in writing or when required by law.