Medical Practice Privacy Policy

Notice of Privacy Practices

Effective Date: [INSERT DATE]

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.

Our Commitment to Your Privacy

[Practice Name] is dedicated to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the confidentiality of your health information and provide you with this notice of our legal duties and privacy practices.

How We May Use and Disclose Your Information

Treatment

• Consulting with other healthcare providers about your care
• Scheduling and coordinating medical services
• Sending prescriptions to your pharmacy

Payment

• Verifying insurance coverage
• Processing claims with your insurance company
• Collecting payments for services rendered

Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training medical students
• Compliance audits

Your Health Information Rights

You have the right to:

1. Request restrictions on certain uses of your PHI
2. Receive confidential communications
3. Inspect and copy your health record
4. Request amendments to your health record
5. Receive an accounting of disclosures
6. Obtain a paper copy of this notice

Changes to This Notice

We reserve the right to change this notice. We will post a copy of the current notice in our facility with the effective date.

Contact Information

If you have questions about this notice, please contact:

[Practice Privacy Officer] [Address] [Phone Number] [Email]