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Notice of Privacy Practices for Protected Health Information (PHI)

Effective Date: September, 1st 2023

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your
privacy. This notice is intended to inform you of your rights and our obligations regarding your Protected
Health Information (PHI).

Our Policies

1. Confidentiality & Sharing of Information:

• Patient information will be kept confidential except as is necessary to provide services or
to ensure that all administrative matters related to your care are handled appropriately.
This specifically includes the sharing of information with other healthcare providers,
laboratories, health insurance payers as is necessary and appropriate for your care.
Patient files may be stored in open file racks and will not contain any coding which
identifies a patient’s condition or information which is not already a matter of public
record. The normal course of providing care means that such records may be left, at
least temporarily, in administrative areas such as the front office, examination room, etc.
Those records will not be available to persons other than office staff.

2. Appointment Reminders:

• We may remind you of your appointments via telephone, e-mail, U.S. mail, or any means
convenient for the practice and/or as requested by you.


3. Third-Party Vendors:

• We utilize various vendors in the conduct of our business. These vendors may have
access to PHI but must agree to abide by HIPAA confidentiality rules.


4. Inspections and Reviews:

• You agree to inspections of the office and review of documents, which may include PHI,
by government agencies or insurance payers in the normal performance of their duties.

5. Concerns and Complaints:

• Please bring any concerns or complaints regarding privacy to the attention of the office
manager or the doctor.

6. Marketing and Advertising:

• Your confidential information will not be used for marketing or advertising purposes.

7. Access to Records:

• We agree to provide you with access to your records in accordance with state and
federal laws.

8. Changes to This Policy:

• We reserve the right to change, add, delete, or modify any of these provisions to better
serve both the practice and the patient.

Contact Us

If you have any questions about this Notice of Privacy Practices or would like to file a complaint
regarding the handling of your Protected Health Information, please don't hesitate to contact us:

Office Manager: Alejandra Rosenberg
Phone: (262) 242-0700
Fax: (855) 457-1293
Office Address: 1516 W Mequon Rd., STE 103, Mequon WI, 53092

We are committed to maintaining the privacy and security of your Protected Health Information and are
here to address any concerns you may have. Please feel free to reach out to us at any time.

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