NOTICE OF PRIVACY PRACTICES
This Notice describes how Health information about you may be used and disclosed and how you get access to this information.
The privacy of your health information is important to us.
Our Legal Duty
We are required by applicable Federal and State law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This notice takes effect 09/.14/2005 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy policies and the new terms of our Notice effective for all health information that we maintain. Including health information we created or received before we make the changes. Before we make a significant change in our privacy practices we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practice or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
Uses and Disclosures of Health Information
We use and disclose health information about your treatment, payment and healthcare operations, For example:
TREATMENT: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
PAYMENT: We may use and disclose your health information to obtain payment for services we provide to you.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
YOUR AUTHORIZATION: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization we can not use or disclose your health information for any reason except those described in this Notice.
TO YOUR FAMILY AND FRIENDS: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
PERSONS INVOLVED IN CARE: We may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, your location, your general condition or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement to your healthcare. We will also use our professional judgment and our experience with common practice to make the best healthcare decisions.
NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT
Salem Foot and Ankle Specialists
1934 Braeburn Drive
Salem, VA 24153
I have seen the Notice of Privacy Practices and have been provided an opportunity to review it.