Effective Date of this Notice:_____________
Richard L. Zeff, M.D., P.A.
137 Portsmouth Avenue, Stratham, N.H. 03885
603-775-7444
NOTICE OF PRIVACY PRACICES
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 SUED 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 you. We are required by law to maintain the confidentiality of
health 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 revision or amendment to this notice will be effective for all of your records
that our practice had 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
Notice in our offices in a visible location at all times, and you may request a copy of our
most cur