Effective Date: April 7, 2003
Drs. Fine, Hoffman & Packer, LLC
1550 Oak Sreet, Suite 5
Eugene, OR 97401
541-687-2110
www.finemd.com
NOTICE: PATIENT PRIVACY
We are required by law to protect the privacy of your medical information and to provide you with
written Notice describing:
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
We may use or disclose to others your medical information for purposes of providing or arranging
for your health care, the payment for or reimbursement of the care that we provide to you, and the
related administrative activities supporting your treatment.
We may be required or permitted by certain laws, regulations, or circumstances to use and
disclose your medical information for certain purposes without your authorization. Under other
circumstances we may need your written authorization (that you may later revoke) in order to use
or disclose your medical information.
As our patient, you have important rights relating to inspecting and copying your medical
information that we maintain, amending or correcting that information, obtaining an accounting of
our disclosures of your medical information, requesting that we communicate with you
confidentially, requesting that we restrict certain uses and disclosures of your health information,
and complaining if you think your rights have been violated.
We have available a detailed NOTICE OF PRIVACY PRACTICES which fully explains your rights
and our obligations under the law. We may revise our NOTICE from time to time. The Effective
Date at the top right hand side of this page indicates the date of the most current NOTICE in
effect.
You have the right to receive a copy of our most current NOTICE in effect. If you have not yet
received a copy of our current NOTICE, please ask at the front desk and we will provide you with
a copy.
If you have any questions, concerns or complaints about the NOTICE or your medical
information, please contact Laurie Brown of our office at 541