Concierge Medicine Practice Privacy Policy

Introduction

This Privacy Policy describes how [Practice Name] ("we," "our," or "the Practice") collects, uses, maintains, and discloses personal health information (PHI) and other personal information from our concierge medicine members ("patients," "you," or "members").

Information We Collect

Medical Information

• Complete health history
• Current medical conditions
• Medications and supplements
• Laboratory and diagnostic test results
• Treatment plans and medical records
• Family medical history

Personal Information

• Name, address, and contact details
• Date of birth and demographic information
• Insurance information (if applicable)
• Emergency contact information
• Payment and billing information

Use of Information

We use collected information to:

• Provide personalized medical care
• Coordinate with other healthcare providers
• Process membership payments
• Schedule appointments
• Send health reminders and updates
• Comply with legal requirements

Information Protection

We implement appropriate security measures including:

• Electronic health record encryption
• Secure server storage
• Limited staff access
• Regular security audits
• HIPAA-compliant communication systems

Information Sharing

We may share your information with:

• Other healthcare providers involved in your care
• Laboratory and diagnostic facilities
• Emergency medical services when necessary
• Legal authorities when required by law

Patient Rights

You have the right to:

• Access your medical records
• Request amendments to your information
• Receive an accounting of disclosures
• Request restrictions on information sharing
• Obtain a paper copy of this notice

Changes to Privacy Policy

We reserve the right to modify this policy. Members will be notified of significant changes.

Contact Information

Privacy Officer: [Name] Phone: [Phone Number] Email: [Email Address]

Effective Date

[Date]

Acknowledgment

I acknowledge receipt of this Privacy Policy:

Signature: _________________ Date: _________________