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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.

Use and Disclosure of Protected Health Information
Each time you visit our office, a record of your visit is made.  This record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment.  This information may be used and disclosed by your physician, our office staff and others outside of our office that are involved with your care and treatment for the purpose of providing health care services to you, to obtain payment for your heath care bills, to support the operation of the physician's practice and other uses as required by law. 

In most cases we must have your authorization in order to release your protected health information.  You may revoke your authorization, at any time, in writing.  No future disclosure will be made once you have revoked this authorization.

Treatment  We will use and disclose your protected health information on an as needed basis for providing your care or treatment.  This includes other providers who are involved in your care or medical treatment outside of our facility.

Payment  Your protected health information will be used, as needed, to obtain payment for your health care services. 

Healthcare Operations   We may use or disclose, as needed, your protected health information in order to support the business activities of our office.

We may disclose your protected health information in the following situations without your authorization:  Reporting of communicable diseases to the Health Department, reporting of suspected cases of abuse and neglect to the appropriate authorities, provision of information to medical examiners, cases of military activity and national security, and worker's compensation.

Understanding what is in your record and how your health information is used helps you to: 1) ensure its accuracy, 2) better understand who, what, when and why others may access your health information and 3) make more informed decisions when authorizing disclosure to others. 

Your Rights
The following is a statement of your rights with respect to your personal health information.

You have the right:

To receive a copy of your protected health information.  This includes protected health information that is subject to a law that prohibits access to such information. 

To request a restriction of your protected health information.  This means you may ask us not to use or disclose any part of your health information for the purposes of treatment, payment or healthcare operations.  Your request must state the specific restriction requested and to whom you want the restriction to apply.  The Duluth Family Practice Center is not required to agree to a restriction that you request.  You have the right to seek care at another facility if you chose to restrict disclosures we believe are necessary.

To obtain a paper copy of this Notice of Privacy Practices. 

To request communications of your health information by alternative means or at alternative locations.  

To amend your health record.

To receive an accounting of certain disclosures we have made, if any, of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. 

This notice was published and
effective on/or before
April 14, 2003.