NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you may be used and disclosed
and how you can get access to this information.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form and are kept properly confidential. This Act gives you, the patient, the right to understand and control how your health information is used. As required by HIPAA, 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 may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.

Treatment means providing, coordinating, or managing health care and related services by one or more heath care providers.

Payment means such activities as obtaining reimbursement for services, confirming coerage and billing or collection activities.

Health Care Operations include the business aspects of running our practice.

Any other uses and disclosures will be made only with your written authorization. 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.

• You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to your doctor.
• The right to request restrictions on disclosures of protected health information. 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 inspect and copy your protected health information.
• The right to amend your protected health information.
• The right to receive an accounting of disclosures of protected health information.
• The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of April 15, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with our office, or with the Department of Health & Human Services, Office of Civil rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint. Please contact us for more information. For more information about HIPPA or to file a complaint: The U.S. Department of Health & Human Services, Office of Civil Rights, 200 Independence Avenue, SW, Washington, D.C. 20201 (202) 619-0257

Call (630) 377-3535 or e-mail goodmand3@comcast.net

If you wish to discuss your concerns, please leave your phone number and our practice manager will contact you. By leaving an e-mail or voice-mail message, you are under no obligation, but we will be happy to discuss ways in which we might be helpful to you.

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