Notice of Privacy Practices for Concierge Medical Services

Effective Date: [INSERT DATE]

Our Commitment to Your Privacy

At [PRACTICE NAME], we are committed to maintaining the privacy of your protected health information (PHI). This Notice describes how medical information about you may be used and disclosed and how you can access this information.

Your Health Information Rights

You have the right to:

• Obtain a copy of your paper or electronic medical record
• Request corrections to your medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we've shared your information
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Our Uses and Disclosures

We may use and share your information as we:

• Provide personalized concierge medical care
• Bill for your services
• Run our organization
• Comply with the law
• Address workers' compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

Special Considerations for Concierge Medicine

• 24/7 Access: Your health information may be accessed by your physician outside normal business hours to provide comprehensive care
• Enhanced Communication: We may use various secure communication methods, including text messaging and email, as agreed upon in your membership agreement
• Third-Party Services: We may share information with third-party services that enhance your concierge experience (with your explicit consent)

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your protected health information
• Notify you promptly if a breach occurs that may compromise your information
• Follow the duties and privacy practices described in this notice
• Give you a copy of this notice

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to health information we already have, as well as any information we receive in the future.

Contact Information

Privacy Officer: [NAME] Phone: [PHONE] Email: [EMAIL] Address: [ADDRESS]