Notice of Privacy Practices for Cardiology Services

[Practice Name] Cardiology Services

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 cardiology 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

Treatment

• Sharing information with other healthcare providers involved in your cardiac care
• Coordinating services with primary care physicians
• Consulting with other specialists regarding your cardiac condition

Payment

• Submitting claims to your insurance company
• Obtaining prior authorization for cardiac procedures
• Billing and collection activities

Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training cardiology fellows and medical students
• Licensing and credentialing

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

1. Right to Inspect and Copy
2. Right to Amend
3. Right to an Accounting of Disclosures
4. Right to Request Restrictions
5. Right to Confidential Communications
6. Right to 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.

Complaints

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

Contact Information

[Practice Name] Address: [Address] Phone: [Phone] Email: [Email]