Notice of Privacy Practices for Oncology Services

[Practice Name] Oncology Services

Effective Date: [Date]

Our Commitment to Your Privacy

We understand that medical information about you and your health is personal. We are committed to protecting your medical information and following all laws regarding the use of your health information.

How We May Use and Disclose Your Medical Information

For Treatment

• Coordinating care with other oncologists and specialists
• Sharing information with radiation therapy centers
• Communicating with pharmacies about chemotherapy protocols

For Payment

• Submitting claims to your insurance company
• Verifying coverage for specific cancer treatments
• Obtaining prior authorizations for procedures

For Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training oncology fellows and medical students

Your Rights Regarding Your Medical Information

1. Right to Inspect and Copy

   • Access to medical records and imaging results
   • Copies of treatment plans and protocols

2. Right to Amend

   • Request corrections to your health information
   • Submit written amendments to your record

3. Right to an Accounting of Disclosures

   • List of when we shared your information
   • Details of information disclosed

Special Situations

Research

We may use your information for cancer research after obtaining proper authorization.

Public Health Activities

Reporting to cancer registries and required state databases.

Contact Information

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

Acknowledgment

I acknowledge receipt of this Notice of Privacy Practices:

Signature: _________________ Date: _____________________