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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.
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you.
Law Requires Us To:
1. Keep your medical information private
2. Give you this notice describing our legal duties, privacy practices and your rights regarding your medical information
3. Follow the terms of the current notice.
We Have the Right to:
1. Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.
2. Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
Notice of Change to Privacy Practices:
1. Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
1. Look or get copies of certain parts of your medical information. You must make your request in writing.
2. Receive a list of all times we or our business associates shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.
3. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement.
4. Request that we change certain parts of your medical information. We may deny your request if we did not create the information you want changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
5. If you have received this notice electronically, and you wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to us.
If you have any questions about this notice or if you think that we may have violated your privacy rights, please email firstname.lastname@example.org.
You may also submit a written complaint to the U.S. Department of Health and Human Services.
Medical Dental Building
509 Olive Way, Suite 1133
Seattle, WA 98101
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