Notice of Privacy Practices for Geriatric Care

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 individually identifiable health information (also called protected health information, or PHI). We are required by law to maintain the confidentiality of health information that identifies you and to provide you with this notice of our legal duties and privacy practices.

How We May Use and Disclose Your PHI

For Treatment

• Share information with other healthcare providers involved in your care
• Coordinate services with nursing homes or assisted living facilities
• Communicate with your family caregivers as authorized

For Payment

• Bill and collect payment from you, your insurance company, or other third party
• Verify coverage and benefits

For Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training of medical students
• Compliance and licensing activities

Special Circumstances

• Public health activities
• Health oversight activities
• Law enforcement
• Deceased patient information
• Serious threats to health or safety

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 Request Confidential Communications
6. Right to a Paper Copy of This Notice

Changes to This Notice

We reserve the right to change this notice at any time 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] Address: [ADDRESS]