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Dan W. Gilbert, O.D.
Notice of Privacy The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a federal program that requires that all medical records and other individually indentifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly condidential. This Act gives you, the patient, significant new rights to understand and control how you health information is used. "HIPAA" provides penalties for covered entities that misuse personal health information. As required by "HIPAA", we have prepared this explaination of how we are required to maintain the privacy of your health information and how we may use and disclose your health information. We may use and disclose your medical records only for each of the following purposed: treatment, payment and health care operations. We may also create and distribute de-identified health information by removing all references to individually indentifiable information. We may contact you to provide appointment reminders of information about treatment alternatives or other health-related benefits and services that may be of interest to you. -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 any 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. We are required by law to maintain the privacy of your protected information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. This notaice is effective as of April 14, 2003 and we are reequired 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 prtected health information that we maintain. We will post and you may request a wrtiin copy of a revised Notice of Privacy Practices fron this office. You have recourse if you feel that your privacy protection has been violated. You have the right to file written complaint with our office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint. The U.S. Department of Health & Humans Services Office of Civil Rights |