We Protect Your Information

We are committed to providing quality health care and respecting the privacy and confidentiality of your medical information. Our policies and procedures, outlined below, conform to state and federal laws. This notice describes how your medical information may be used and disclosed and how you can get access to your information. Please review it carefully.

Effective date: April 14, 2003
Revised: September 2013

Information we need from you:

When you arrive at our practice for your appointment, we will ask you to sign in by writing your name on a designated form in our waiting room.

In order to contact you, we need current contact information. Please complete the registration form, and provide your current telephone numbers (home, work, cell; please designate which one is your preferred contact) and home address.

We may need to contact you by telephone to discuss your appointments, test results, treatment, referrals, account balance, or simply to return your phone call. We would first attempt to call you at the number you designate as your preferred number. However, if you are not available, we would call you at the other phone numbers you have provided. We may leave a message for you to call the office. We may also leave information to remind you of an upcoming appointment.

We may mail correspondence to your home. Such correspondence may regard test results, appointments, and/or medical or non-medical information you have requested. In the event you do not pay all of your charges at the time of your visit, we will mail a statement to your home.

In order to honor your request to release or send medical records to third parties, you will be required to sign a medical release form, which will be provided by this office.

What we do with your information:

So that we may provide you/your child with appropriate medical care, perform general practice functions, and/or obtain payment, we will (at our discretion) provide information regarding the treatment received in this practice, the charges involved, and related information to other healthcare entities, such as:

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