Section 5: Summary of Notice of Privacy Practices

This summary is provided to assist you in understanding the Notice of Privacy Practices.

The Notice of Privacy Practices contains a detailed description of how our office will protect your health information, your rights as a patient and our common practices in dealing with patient health information. Please refer to the Notice for further information. You may obtain this notice from our receptionist if you have not already been given one at the time of check in.

OFFICE SETTING. Our office has three exam rooms available for daily patient care. Two of these rooms are open as in a dental setting. Conversation can be heard by others. You may request to be seen in our closed exam room at the time you check in with our receptionist. Please note that this may cause a delay in your treatment if you do decide on this option. Our office will do everything to maintain your privacy.

USES & DISCLOSURES OF HEALTH INFORMATION. We will use and disclose your health information in order to treat you or to assist other health care providers in treating you. We will also use and disclose your health information in order to obtain payment for our services or to allow insurance companies to process Insurance claims for services rendered to you by us or other health care providers. Finally, we may disclose your health information for certain limited operational activities such as quality assessment, licensing, accreditation and training of students.

USES AND DISCLOSURES NOT REQUIRING YOUR AUTHORIZATION. In the following circumstances we may disclose your health information without your written authorization.

• To family members or close friends who are involved in your health care
• For certain limited research purposes
• For purposes of public health and safety
• To government agencies for purposes of their audits, investigations and other oversight activities
• To government authorities to prevent child abuse or domestic violence
• To the FDA to report product defects or incidents
• To law enforcement authorities to protect public safety or to assist in apprehending criminal offenders
• When required by court orders, search warrants, subpoenas and as otherwise required by the law.

PATIENT RIGHTS. As our patient, you have the following rights:

• To have access to and/or a copy of your health information
• To receive an accounting of certain disclosures we have made of your information
• To request restrictions as to how your health information is used or disclosed
• To request that we communicate with you in confidence
• To request that we amend your health information
• To receive notice of our privacy practices

If you have a question, concern or complaint regarding our privacy practices, please refer to the Notice of Privacy Practices for the person or persons whim you may contact.

Rion A. Berg D.P.M
Board Certified in Foot Surgery
Lake City Professional Center
2611 NE 125th St., Ste.130
Seattle, Washington 98125
Phone: (206) 368-7000
Fax: (206) 361-9273