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.
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:
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)