Effective Date: 10/28/2025
 

Our Legal Duty
We are required by law to maintain the privacy of your protected health information (PHI),
provide this Notice describing our legal duties and privacy practices, and notify you
following a breach of unsecured PHI.
 

How We May Use and Disclose Your Health Information
We may use and share your information for treatment, payment, and health care
operations.
 

Treatment: To provide, coordinate, or manage your care and share information with other
healthcare providers involved in your treatment.
Payment: To bill and obtain payment from your insurance company or another responsible
party.
 

Health Care Operations: For office management, quality assessment, and staff training.
Other Uses and Disclosures Permitted or Required by Law
We may share your information when required or allowed by law, such as for public health
reporting, health oversight agencies, legal proceedings, law enforcement, workers’
compensation, or to prevent a serious threat to health or safety.

Uses and Disclosures Requiring Your Authorization
Any other use or disclosure of your PHI, such as for marketing or to family members,
requires your written authorization. You may revoke any authorization in writing at any
time.

Your Rights Regarding Your Health Information
You have the right to:
1. Access your records.
2. Request corrections.
3. Request restrictions on use or disclosure.
4. Request confidential communications.
5. Receive an accounting of disclosures.
6. Receive a copy of this Notice.
7. File a complaint without retaliation.

Our Responsibilities
We are required by law to maintain the privacy and security of your health information. We
will notify you promptly if a breach occurs and follow the terms of this Notice.

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Changes to This Notice
We may change this Notice at any time. Updated versions will be posted in our office and on
our website. The new Notice will apply to all health information we maintain.