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HIPAA Privacy Notice
 

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

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Our Responsibilities:

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• We are required by law to maintain the privacy of your protected health information (PHI).

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it upon request.

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How We May Use and Disclose Your Health Information:

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• For Treatment: We may use your health information to provide you with medical treatment or services.

• For Payment: We may use and disclose your health information to bill and collect payment for the services we provide to you.

• For Healthcare Operations: We may use and disclose your health information for activities such as quality assessment, employee review, and training.

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Your Rights:

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• You have the right to inspect and obtain a copy of your health information.

• You have the right to request an amendment to your health information.

• You have the right to request restrictions on how we use and disclose your health information.

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Complaints:

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• If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.

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Contact Information:

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If you have any questions or concerns about this notice or about how your health information may be used or disclosed, please contact [Provider Name] at [Contact Information].

By signing below, you acknowledge that you have received a copy of this HIPAA Privacy Notice.