Patient 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.
This Privacy Notice is being provided to you as a requirement of a federal law, the Health
Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your
protected health information to carry out treatment, payment, or health care operations and for other purposes that
are permitted or required by law. It also describes your right to access and control your protected health information.
Your “protected health information” means any written or oral information about you, including demographic
data that can be used to identify you, created or received by your health care provider, which relates to your past,
present, or future physical or mental health or condition.
Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations
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Uses and Disclosures of Protected Health Information Permitted without Authorization or
Opportunity for the Individual to Object
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Uses and Disclosures of Protected Health Information Permitted without Authorization but with
an Opportunity for the Individual to Object
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Uses and Disclosures of Protected Health Information which You Authorize
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Your Rights Regarding Your Protected Health Information
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Your Rights Regarding Your Protected Health Information
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Your Rights Regarding Your Protected Health Information
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Contact Information
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Effective Date
This Notice is effective April 14, 2003.
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