Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND ENCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

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The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law given you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information. 

Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operation. 

            ٱ The right to request restrictions on certain uses and disclosures of protected health information, including those related to
                disclosures to family
                members, other relatives, close personal friends, or nay other person identified by you. We are, however, not required to
                agree to a requested
                restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
            ٱ The right to request to receive confidential communications of protected health information from us by alternative means or
                at alternative locations.
            ٱ The right to access, inspect and copy your protected health information.
            ٱ The right to request an amendment to your protected health information.
            ٱ The right to receive an accounting of disclosures of protected health information outside of treatment, payment and health
                care operations.
            ٱ The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. 

This notice is effective as of 4-1-2003, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office.
 

You have the right to file a formal, written complaint with us at on of the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint. 

For more information about our Privacy Practices, please contact:

Woodbridge                                         Alexandria
 12500 Lake Ridge Dr.                          8403-I Richmond Hwy
 Woodbridge VA 22192                        Alexandria, VA 22309
 (703) 494-3176                                    (703) 360-1070

For more information about HIPAA or to file a complaint, contact:
The U.S. Department of Health & Human Services, Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: (877) 696-6775 (toll-free)

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Click here, to print our your Acknowledgment of Privacy Practices Form