Notice of Privacy Practices for Protected Health Information

This Notice describes how medical information about you may be used and disclosed as well as how you may access this information. Please review it carefully!

Your Health Information Rights:

The health record we maintain and pulled records are the physical property of the practice; however, information

within those records belongs to you. You have a right to:

  • – Request, in writing delivered to our office, a restriction on certain uses and disclosures of your health information. We are not required to grant the request, but we will comply with any granted requests
  • – Request, in writing delivered to our office, to inspect and copy your health and billing records
  • – Appeal a denial of access to your protected health information except in certain circumstances
  • – Request, in writing delivered to our office, to have your health care record be amended to correct incomplete or incorrect information
  • – File a statement of disagreement if your amendment is denied, and require the request for amendment and denial to be attached in all future disclosures of your protected health information
  • – Obtain an accounting of disclosures of your health information as required to be maintained by law through a written request delivered to our office. An accounting will NOT include: internal uses of information for treatment, payment, or operations, disclosures made to you/at your request, or disclosures made to family members/friends while providing care to you
  • – Request, in writing delivered to our office, that communication of your health information be made by alternative means or at an alternative location
  • – Revoke previously made authorizations to use or disclose information except to the extent that information or action has already been taken by delivering a written revocation to our office

To exercise any of the rights stated above, please contact our office at (703) 729-7447. We will provide you with assistance on the steps needed to exercise your rights.

You have the right to review this Notice before authorizing use and disclosure of your protected health information for treatment, payment, and health care operations.

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