Patient Information Practices

NOTICE OF PATIENT INFORMATION PRACTICES

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

ALLTECH O & P SERVICES, LLC LEGAL DUTY

Alltech O & P, LLC is required by law to protect the privacy of your personal health information, provide this notice about your information practices, and follow the information practices that are described herein.

USE AND DISCLOSURES OF HEALTH INFORMATION

Alltech O & P Services, LLC uses your personal health information primarily for treatment, obtaining pay for treatment, conducting internal administrative activities, and evaluation of the quality of care that we provide. For example, Alltech O & P Services, LLC may use your personal health information to contact you to provide appointment reminders, or information about treatment alternatives or other health related benefits that could be of interest to you. Alltech O & P Services, LLC may also use or disclose your personal health information without prior authorization for public health purposes, for auditing purposes, for research studies, and for emergencies. We also provide information whenever required by law. In any other situation, Alltech O & P Services’ policy is to obtain your written authorization before disclosing your personal health information. If you provide us with a written authorization to release your information for any reason you may later revoke that authorization to stop further disclosures at any time. Alltech O & P Services, LLC may change its policy at any time. When changes are made, a new notice of information practices will be posted in the waiting room, on our website, and will be provided to you on your next visit. You may also request an updated copy of our notice of information practices at any time.

PATIENT’S INDIVIDUAL RIGHTS

You have the right to review or obtain a copy of your personal health information for treatment, payment, and administrative purposes except when specifically authorized by you, when required by law or in emergency circumstances. Alltech O & P Services, LLC will consider all such requests on a case-by-case basis, but the practice is not legally required to accept them.

CONCERNS AND COMPLAINTS

If you are concerned that Alltech O & P Services, LLC may have violated your privacy rights or if you disagree with any decisions we have made regarding access or discloser of your personal health information, please contact our practice manager at the address listed below. You may also send a written complaint to the US Department of Health and Human Services. For further information on Alltech O & P Services, LLC health information practices or if you have a complaint, please contact the following person: Shelly DeLeon, Office Manager shelly@alltechop.com Ph: 817-484-9699 / Fax: 817-484-9877