Effective Date: 01/01/03

The information provided below illustrates the manner your protected health information could be accessed and released and what you need to know about this process.
This important document should be reviewed thoroughly. Managing the privacy of your protected health information is extremely important to Dr. Gordon Wilson.

Dr. Gordon Wilson’s Legal Responsibilities
As mandated by federal and state legal requirements, your protected health information must be safeguarded. These regulations require us to:

• Make you aware of our privacy policies, legal duties, and your rights

• Follow the terms of this notice as long as it is in effect

We reserve the right to change our privacy policies and this notice at any time. Changes may apply to all protected health information we maintain, including what was created or received before the change. A copy of the current notice will always be available upon request.

Copies of this notice are available at your request. Contact details are provided at the end of this notice.

Protected Health Information Use and Disclosure
Your health information may be used or disclosed for:

Treatment – Provided to a physician or other healthcare provider giving care to you.
Payment – Used to obtain payment for services rendered.
Healthcare operations – Used for processes like quality assessments, training, licensing, and certification.

Your Authorization
You may give written authorization for use and disclosure of your information for other purposes. You may revoke this authorization in writing at any time. Revocation does not affect prior use or disclosure.

Your information may also be shared with individuals involved in your care, but only with your authorization.

Person Involved in Care
We may use or disclose your information to notify family members or others of your location, condition, or death. If you are present, you can object. If you’re incapacitated or in an emergency, we will use our professional judgment.

Other Uses and Disclosures

Marketing communications – Not allowed without your written authorization.
Required by law – Disclosure may be required.
Abuse or neglect – Disclosure may be made to authorities as required by law.
National security and military – May be disclosed as required by appropriate authorities.
Correctional institutions and law enforcement – May be shared if you are in custody and disclosure is legally permitted.

Appointment Reminders
We may use your information to send reminders via voicemail, postcards, or letters.

Patient Rights

Access – You have the right to review your information, with limited exceptions.
Requests must be in writing. You may:

• Submit a Protected Health Information Access Form

• Send a written letter to the contact listed at the end of this notice

We may charge reasonable, cost-based fees for:

• Copies

• Staff time

• Postage (if mailing)

• Special formats (upon request)

Disclosure Accounting
You may request a record of disclosures made (not including treatment, payment, or healthcare operations) for the past six years after April 14, 2003. A fee may apply for more than one request per year.

Restrictions
You may request limits on how we use or disclose your information. We are not required to agree but will follow any agreed-upon restrictions unless it’s an emergency.

Alternative Communications
You may request communication by different means or at alternate locations. Requests must be in writing and should include any payment arrangements if applicable.

Amendments
You may request corrections to your information in writing, with an explanation. We may deny requests in some cases.

Electronic Notice
If you receive this notice electronically, you may request a paper copy.

Questions and Complaints
If you have concerns or feel your rights were violated:

• Contact our office directly

• File a complaint with the U.S. Department of Health and Human Services (we can provide the address upon request)

We are committed to your privacy and will not retaliate for filing a complaint. We’re here to assist you with any questions or concerns.