THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY NOT BEUSED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION, PLEASE REVIEW IT CAREFULLY.
Your protected health information (i.e., individually identifiable information, such as names, dates, phone/fax numbers, email addresses, home addresses, social security numbers, and demographic data) may be used or disclosed by usin one or more of the following respects:
Any other uses or disclosures of your protected health information will be made only after obtaining your written authorization, which you have the right to revoke.
Under the new privacy rules, you have the right to:
We have the following duties under the privacy rules:
Please notes that we are not-obligated to:
This privacy notice is effective as of the date of your signature. If you have any questions about the information in this Notice, please ask our Privacy Contact Person or direct your questions to this person at our office. Thank you.
I hereby acknowledge that I have received and reviewed a copy of this Privacy Notice.