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.

Our commitment

Tulsa Neuropathy Center is required by law to protect the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect.

How we may use and disclose your information

• Treatment — to provide and coordinate your care.
• Payment — to bill and obtain payment from you or your insurer.
• Health care operations — for quality, training, and administration.
• As required by law — including public health and safety reporting.

Other uses and disclosures not described here will be made only with your written authorization, which you may revoke at any time.

Your rights

• Inspect and request a copy of your health record.
• Request a correction to your health information.
• Request confidential communications and reasonable restrictions on disclosure.
• Receive an accounting of certain disclosures.
• Receive a paper copy of this notice on request.
• File a complaint if you believe your privacy rights were violated.

Contact

To exercise any of these rights or to file a complaint, contact us at (918) 740-9476 or 7233 S 85th East Ave, Suite 100, Tulsa, OK 74133. You will not be penalized for filing a complaint.

This is a general template and must be reviewed and customized by the clinic's compliance officer or legal counsel before use.