We respect our legal obligation to keep health information that identifies you private.  As obligated by law, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.  We do not use your health information in our office or disclose it outside of our office without your written permission.  In some limited situations, the law requires us to disclose your health information without either written or verbal consent.  We will ask you to sign a consent form allowing us to use and disclose your health information for purposes of treatment, payment, and health care operations in this office.  We are allowed to refuse to treat you if you do not sign the consent form.    We are permitted to use and disclose your health care records for the purpose of treatment, payment, and health care operations:

  • Treatment means providing coordination, or managing health care related services by one or more health care providers.  For example, we may need to share information with other providers or specialists involved in your care.
  • Payment means activities as obtaining reimbursement for services, verifying coverage, billing or collection activities, and utilization review.  For example, we may disclose treatment information when billing a medical plan for you.
  • Health care operations include the business aspects of running our practice.

You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization or as permitted by law.     In some limited situations, the law requires us to use and disclose your health information without your permission.  These examples may never come up at our office at all, but such disclosures are:

  • When a state or federal law mandates that certain health information be reported for a specific purpose.
  • For public health purposes, such as contagious disease reporting and notices to and from the FDA regarding drugs and medical devices.
  • Disclosure to government authorities about victims of suspected abuse, neglect, or domestic violence.
  • Uses and disclosures for health oversight activities, such as for the audits by your insurance plan, or for investigation of possible violation of health care laws.
  • Disclosures in response to subpoenas or orders of the court.
  • Disclosures for law enforcement purposes, such as to provide information about someone who is suspected to be a victim of a crime, or to provide information about a crime at our office. 
  • Disclosure related to worker’s compensation programs.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

  • The right to request restrictions on certain uses and disclosures of protected health information to any person identified by you.  We are, however, not required to agree to a requested restriction.  If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
  • The right to ask us to communicate to you in a confidential way, such as by phoning you at work rather than at home or by mailing health information to a different address.  Please provide a written request.
  • The right to ask to see or to get photocopies of your health information.  You may have to pay for photocopies in advance. 
  • The right to receive an accounting of disclosures of protected health information.
  • The right to amend your protected health information.
  • The right to obtain a paper copy of this notice from us upon request.

We do charge a fee to release your records to an outside source other than a health care provider (examples are lawyers, health care research firm, etc).  Please complete our written records request for billing or medical record release.   This notice was originally effective March 17, 2003 and was revised on January 1, 2007.  We are required to abide by the terms of this Notice of Privacy Practices and to make the new notice provisions effective for all protected health care information that we maintain.  You have the right to file a formal, written complaint with the Department of Health and Human Services, Office of Civil Rights.  In the event you feel that your privacy rights have been violated, please contact us or the United States Department of Health and Human Services. 


True Response Synchronicity Producitons: singthewind.com


Monday - Thursday: 9:00am - 6:30pm

 Friday: Closed

Saturday: 10:00 am - 4:00 pm

Sunday : Closed