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Our Privacy Pledge
			We are very concerned with protecting your privacy. While the law requires us to give you this disclosure, please understand that we have always respected the privacy of your health information, and we always will.
There are several circumstances in which we may have to use or disclose your health information. u We may have to disclose your health information to another health care provider or a hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition. u We may have to disclose your health information and billing records to another party if they are potentially responsible for the payment of your services. u We may need to use your health information within our practice for quality control or other operational purposes. We have a more complete notice that provides a detailed description of how your health information may be used or disclosed. You have the right to review that notice before you sign a consent form (§ 164.520). We reserve the right to change our privacy practices as described in that notice. If we make a change to our privacy practices, we will notify you in writing when you come in for treatment or by mail. Please feel free to call us at any time for a copy of our privacy notices. Your Right to Limit Uses or Disclosures You have the right to request that we do not disclose your health information to specific individuals, companies, or organizations. If you would like to place any restrictions on the use or disclosure of you health information, please let us know in writing. We are not required to agree to your restrictions. However, if we agree with your restrictions, the restriction is binding on us. Your Right to Revoke Authorization You may revoke your consent to us at any time. However, your revocation must be in writing. We will not be able to honor your request if we already released your health information before we receive you request to revoke your authorization. If you were required to give your authorization as a condition of obtaining insurance, the insurance company may have a right to your health information if they decide to contest any of your claims.
Toll Free: (866) 886-3709 Phone: (704) 442-9805 3535 Randolph Rd, Ste 208 Charlotte, NC 28211
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