Sample HIPAA Privacy Summary

SUMMARY NOTICE OF HIPAA PRIVACY PRACTICES



This notice describes how medical information about you may be used and disclosed and you can get access to this information. Please review it carefully.

This is a one-page summary of the longer notice that follows. Please read both the summary and the actual notice.


HIPAA allows me to share your health information without your specific consent in order to:

• Facilitate your treatment
• Get paid by insurance companies
• Transcribe records

I may disclose your health information to the following entitites:

• Other health care providers and therapists
• Insurance companies
• My billing office
• My transcriptionist
• Workers compensation boards
• The FDA
• Law enforcement and DSS

Note: I will NOT share your information with your family without your specific consent, unless somebody’s health is in immediate danger.


You have the right to:

• Get a copy of your medical record
• Change your medical record if you think it's wrong
• Get a list of whom I share your health information with
• Ask me to limit the information I share
• Ask for a copy of my privacy notice
• Complain in writing to me if you believe your privacy rights have been violated