SUMMARY OF NOTICE OF PRIVACY PRACTICES

This summary is provided to assist you in understanding the attached Notice of Privacy Practices.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION:

Except as stated in more detail in the Notice of Privacy Practices, we will not use or disclose your health information without your written authorization.

USES AND DISCLOSURES NOT REQUIRING YOUR AUTHORIZATION:

In the following circumstances, we may disclose your health information without your written authorization:

FOR PURPOSES OF PUBLIC HEALTH AND SAFETY:

• To Government agencies for purposes of their audits, investigations and other oversight activities;
• To government authorities to prevent child abuse or domestic violence;
• To law enforcement authorities to protect public safety or to assist in apprehending criminal offenders;
• When required by court orders, search warrants, subpoenas and as otherwise required by the law.

CLIENT RIGHTS: AS A CLIENT, YOU HAVE THE FOLLOWING RIGHTS:

• To have access to and/or a copy of your health information;
• To receive an accounting of certain disclosures we have made of your health information;
• To request restrictions as to how your health information is used or disclosed;
• To request that we communicate with you in confidence;
• To request that we amend your health information;
• To receive notice of our privacy practices.

CONTACT PERSON:

Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer.
Complaints against the provider can be mailed to Blakely Forrest by US Post mail, or by arrangements can be made by phone.
The appropriate contact information is listed below: