Notice of Privacy Practices for Surgical Care

[Practice Name] General Surgery

Effective Date: [Insert Date]

Our Commitment to Your Privacy

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

Your 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:

• Treat you
• Run our surgical practice
• Bill for your services
• Help with public health and safety issues
• Conduct research (with your consent)
• Comply with the law
• Respond to organ and tissue donation requests
• Work with medical examiners
• Address workers' compensation claims
• Respond to lawsuits and legal actions

Special Protections

We provide additional privacy protections for:

• Operative notes and surgical records
• Pre- and post-operative photographs
• Sensitive diagnostic information
• Mental health information

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 the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request in our office and on our website.

Contact Information

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