Notice of Privacy Practices for Vascular Surgery

[Practice Name] Vascular Surgery

Effective Date: [Date]

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

Our Commitment to Your Privacy

Our 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

• Consulting with other healthcare providers about your care
• Scheduling surgical procedures and follow-up appointments
• Coordinating pre-operative testing and imaging
• Communicating with vascular laboratories and diagnostic facilities

Payment

• Verifying insurance coverage
• Submitting claims for vascular procedures
• Obtaining prior authorizations for surgical interventions
• Collection activities

Healthcare Operations

• Quality assessment activities
• Employee review activities
• Training vascular surgery residents and fellows
• Compliance and risk management

Your Privacy Rights

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

Changes to This Notice

We reserve the right to change this notice at any time. We will post a copy of the current notice in our facility.

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

Acknowledgment

I acknowledge that I have received a copy of this Notice of Privacy Practices.

Patient Signature

Date