Text Box: information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. To request restrictions, you must make a request in writing to the Manager of Medical Records. In your request, you must tell us (1) what information you want to limit (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way. For example, you may request that we only contact you at work, by mail or by email. To request confidential communications, you must make your request in writing to the Manager of Medical Records. We will not ask you the reason for the request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. CHANGES TO THIS NOTICE We reserve the right to change this notice. We reserve the right to make revised notice effective for the medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in an appropriate area in our offices. COMPLAINTS If you have complaints concerning our Privacy Policy, you may contact the Secretary of the Department of Health and Human Services, at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201 (email: ocrmail@hhs.gov). You may also contact us at: Synergy O & P, 1220 Coit, Suite 102, Plano, Texas 75075 To obtain information concerning this Notice of Privacy Practices, you may contact our Privacy Officer: Kim Smith Synergy O & P 1220 North Coit, Suite 102 Plano, Texas 75075 This Privacy Policy is effective April 14,2003

Privacy Practices (page 3)

Dallas Office:

214 239 2970 / fax 214 239 2974

 

Plano Office:

972 769 8344 / fax 972 769 0644

toll free 1-888-285-1411

 

E-mail: webmaster@synergy-op.com

Copyright 2002, 2008 - Pinnacle Design Web Publishing Enterprises