Notice of Privacy Practices
I am committed to maintaining the confidentiality of your medical information. In most cases, your records will not be released without your written consent (which you can revoke However, there are a few exceptions. I am permitted to disclose your medical information to other professionals involved in your treatment.
(1) I may disclose your medical information for public health concerns as mandated by federal or state government.
(2) I am required by law to report abuse or neglect of children, the elderly, disabled, incarcerated or other vulnerable populations.
(3) I may release information if you are under the custody of law enforcement or if ordered by the court.
You may request in writing that I restrict how your information is disclosed for treatment, payment, or healthcare operations. Although I am not required to restrict information, I will do so except in emergency situations.
It is my policy not to release information to family members or individuals without your written consent.
If you are concerned that your privacy rights have been violated, you may contact the person listed below. You may also send a written complaint to the U.S. Department of Health and Human Services. I will not retaliate against you for filing a complaint with me or with the government. The contact information for the United States Department of Health and Human Services is:
U.S. Department of Health and Human Services
7500 Security Blvd., C5-24-04
Baltimore, MD 21244
Promise to you
I am required by law and regulation to protect the privacy of your medical information, to provide you with this notice of privacy practices with respect to protected health information, and to abide by the terms of the notice of privacy practices in effect.
I may change these policies and this notice at any time and have those revised policies apply to all the protected health information I maintain. If or when I change the notice, you will be notified.
I have read the above policy