Effective Date of this Notice: 04/14/03
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Grayson Highlands Family Medicine, LLC
NOTICE OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION
ABOUT YOU (AS A PATIENT OF THIS PRACTICE ) MAY
BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information
(IIHI). In conducting our business, we will create records regarding you and the treatment and services we
provide to you. We are required by law to maintain the confidentiality of h ealth information that identifies
you. We also are required by law to provide you with this notice of our legal duties and the privacy
practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow
the terms of the notice of privacy practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important
information:
• How we may use and disclose your IIHI
• Your privacy rights in your IIHI
• Our obligations concerning the use and disclosure of your IIHI
The terms of this notice apply to all records containing your IIHI that are created or retained by our
practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any re vision or
amendment to this notice will be effective for all of your records that our practice has created or
maintained in the past, and for any of your records that we may create or maintain in the future.
Our practice will post a copy of our current No tice in our offices in a visible location at all times, and
you may request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT