Piedmont Internal Medicine
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact our Privacy Officer:
125 Executive Drive Suite H
Danville, Virginia 24541
We understand that medical information about you and your health is personal and we are committed to protecting that information. We create a record of the care and services you receive at Piedmont Internal Medicine in order to provide you with quality care and to comply with certain legal requirements.
This Notice of Privacy Practices describes how we may use and disclose medical information about you, including demographic information, that may identify you and your related health care services to carry out your treatment, obtain payment for our services, to perform the daily health care operations of this practice and for other purposes that are permitted or required by law. This notice also describes your rights to access and control your medical information.
We are required to abide by the terms of this Notice of Privacy Practices.
2. Written Acknowledgement
You will be asked to sign a written statement acknowledging that you have received a copy of this notice. The acknowledgement only serves to create a record that you have received a copy of the notice.
3. Changes to this Notice
We may change the terms of our Notice, at any time. The new Notice will be effective for all medical information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. To request a revised copy, you may call our office and request that a revised copy be sent to you in the mail or you may ask for one at the time of your next appointment. The current Notice of Privacy Practices will be also posted on our Web site, www.piedmontinternalmedicine.com
4. How We May Use and Disclose Medical Information about You
The following categories describe the different ways that Piedmont Internal Medicine may use and disclose your medical information and a few examples of what we mean. These examples are not meant to describe every circumstance, but to give you an idea of the types of uses and disclosures that may be made by our office. Other uses and disclosures of your medical information that are not listed or described below will be made only with your written authorization. You may revoke this authorization, at any time, in writing, but it will not apply to any actions we have already taken.
Notice of Privacy Practices (HIPPA)
Page 1 of 5
Piedmont Internal Medicine
PIEDMONT REGIONAL MEDICAL CENTER
125 EXECUTIVE DRIVE
DANVILLE, VIRGINIA 24541