Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

We understand that your medical information is personal and we will protect your privacy as the law requires. We may share your protected health information with others for purposes of treatment, payment, and health care operations. "Protected health information" means the personal and medical information we obtain in providing our services to you. Such information may include a list of your symptoms, examination and test results, diagnoses, treatment, medications and applications for future care or treatment. It also includes related billing information. This Notice explains:

Requirement for Written Authorization

Generally, we will obtain your written authorization before using your health information or sharing it with others outside of our organization. There are certain situations where we must obtain your written authorization before using your health information or sharing it, including:


We may not disclose any of your health information for marketing purposes if we will receive direct or indirect financial remuneration not reasonably related to our cost of making the communication.

Sale of Protected Health Information

We will not sell your protected health information to third parties. The sale of protected health information, however, does not include a disclosure for public health purposes, for research purposes where we will only receive remuneration for our costs to prepare and transmit the health information, for treatment and payment purposes, for the sale, transfer, merger or consolidation of all or part of our operations, for a business associate or its subcontractor to perform health care functions on our behalf, or for other purposes as required and permitted by law.

To Request Information or File A Complaint

If you have questions, would like additional information or forms, wish to exercise any of these rights, or feel that your privacy rights have been violated, you may call or write to:

Your benefits will not be affected by any complaints you make. We cannot, and will not, treat you differently if you file a complaint.

Effective Date: April 14, 2003
Amended September 23, 2013