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HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: [Insert Date]
Practice Name: Essential Family Health NP, PLLC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

Our Legal Duty

We are required by applicable federal and state law, including the Health Insurance Portability and Accountability Act (HIPAA), to:

  • Maintain the privacy and security of your Protected Health Information (PHI)
  • Provide you with this Notice of our legal duties and privacy practices
  • Notify you in the event of a breach of unsecured PHI

Uses and Disclosures of Your PHI

1. Treatment

We may use and disclose your PHI to provide, coordinate, and manage your healthcare services.

2. Payment

We may use your information to bill and receive payment for healthcare services.

3. Healthcare Operations

We may use your PHI for:

  • Practice management
  • Quality improvement
  • Administrative functions

Additional Permitted Uses

We may disclose your PHI without your written authorization when required by law, including:

  • Public health activities
  • Health oversight activities
  • Judicial and administrative proceedings
  • Law enforcement purposes
  • To avert a serious threat to health or safety

Your Rights

You have the right to:

  • Access Your Records
    Request copies of your medical records
  • Request Amendments
    Request corrections to your health information
  • Request Restrictions
    Ask us to limit how your information is used or disclosed
  • Confidential Communications
    Request that we contact you in a specific way
  • Accounting of Disclosures
    Receive a list of disclosures made of your PHI

Our Responsibilities

We are required to:

  • Protect the privacy of your PHI
  • Follow the terms of this Notice
  • Provide updates to this Notice when necessary

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

📧 [email protected]

📍 3979 Albany Post Road #629, Hyde Park, NY 12538