Notice of Privacy Practices for Cardiac Surgery

[Practice Name] Cardiac Surgery Department

Effective Date: [Date]

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

Our Commitment to Your Privacy

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

How We May Use and Disclose Your PHI

For Treatment

• Consulting with other healthcare providers about your cardiac care
• Scheduling surgical procedures and related services
• Coordinating pre- and post-operative care
• Managing medications and medical devices

For Payment

• Verifying insurance coverage
• Billing and collections
• Obtaining pre-authorization for procedures

For Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training cardiac surgery residents and fellows
• Compliance and risk management

Special Circumstances

We may disclose your PHI without authorization for:

• Public health activities
• Health oversight activities
• Legal proceedings
• Law enforcement purposes
• Research (with proper approval)
• Emergency situations

Your Rights Regarding Your PHI

You have the right to:

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

Contact Information

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

Acknowledgment

I acknowledge that I have received this Notice of Privacy Practices:

Signature: _________________ Date: _____________________