If you have any questions or comments about this notice please contact:

Fairfax Family Practice Centers, PC
12110 Sunset Hills Road Suite LL20
Reston, VA 20190

Our Privacy Officer is: Pat Rogers, Sr. Practice Administrator, 703-773-2100

Who Does this Notice Apply to?

Fairfax Family Practice Centers, PC, has published this Notice. It applies to everyone who works for Fairfax Family Practice Centers, PC, including our employees, contractors, and volunteers.

Why Do We Publish this Notice?

As medical professionals, we understand that information about you and your health is sensitive and personal. We are also required by law to maintain the privacy of information we gather and use about our patients, and provide them with notices of our legal duties and privacy practices with respect to their information.

While we are committed to the privacy of our patients' information, in order to serve them we need to gather, keep and use records of this information. We sometimes also need to share information with other parties. This Notice is intended to let you know how we use and disclose your information.

This Notice is also to let you know about certain legal rights you have with respect to the information we hold about you. You have certain rights to review and copy our records of information about you. You may also request that we amend these records, and may ask us to account for certain disclosures we may have made of information about you.

When Is This Notice Effective?

We are required to comply with the terms of this Notice while it is in effect. We reserve the right to change the terms of this Notice, and make the new terms effective for all information to which this Notice applies. This Notice will be in effect from April 1, 2003 until the date we publish an amended Notice. If we do publish an amended Notice, we will notify you at your next visit. We will also publish the amended Notice in our offices, and will publish it on our web site if we maintain one.

What Information Does this Notice Cover?

This Notice covers all information in our written or electronic records which concerns you, your health care, and payment for your health care. It also covers information we may have shared with other organizations to help us provide your care, get paid for providing care, or manage some of our administrative operations.

Fairfax Family Practice Centers, PC -Notice of Patient Privacy Practices

When Can We Use or Disclose Information About You?

• Treatment. We may use or disclose information about you for treatment purposes to doctors, nurses, technicians, medical students or other individuals who work in our practice who are involved in providing you with health care. We may also disclose information about you to organizations and individuals involved in your care who are outside of our practice, such as consulting physicians, laboratories, social workers, and so on.

  For example, if we refer you to another physician or a hospital for specialty services, we will provide that physician or hospital with all clinical information, which might be necessary or helpful to help them provide you with the right care. Or, if we need to send a sample of your blood to a laboratory for analysis, we will provide the laboratory with the information they need to process your blood correctly.

  These are only examples, and we may use or disclose information about you to provide you proper treatment in many other ways.

• Payment. We may use or disclose information about you for payment purposes to our clerks and officers involved in billing and claims payment. We may also disclose such information to your health plan or other party financially responsible for your care, or to claims and billing services if necessary.

  For example, if you are covered by a health plan we cannot get paid for the services we provide you unless we submit information in a claim. This might include detailed clinical information, depending on the kind of plan and claim. This is only an example, and there may be many other ways in which we may use or disclose information about you in connection with payment for your care.

• Health care operations. We may use or disclose information about you for operational in connection with our practice. These activities might include practice quality improvement, training of medical students, insurance underwriting, medical or legal review, and business planning or administration of our practice.

  For example, we may wish to review the quality of care you receive, in order to help us deliver the best care we can. Or, we may audit our management practices so we can become more efficient. These are only examples, and we may use or disclose information about you for health care operations in many other ways.

• To a public health agency, for purposes such as controlling disease,

• In case of suspected child abuse, to the appropriate governmental authority,

• In other cases of suspected abuse, neglect or domestic violence, to the appropriate governmental authority, with your agreement or if required by law, or if you are incapacitated or it appears necessary to prevent serious harm to you or others.

• To health oversight authorities, for regulatory, licensing and other legal purposes.

• In litigation, subject to certain requirements controlling the terms of the disclosure.

• To law enforcement agencies, subject to applicable legal requirements and limitations.

• Worker's Compensation: In such cases that your treatment is a result of an injury on the job, we may release your information to the appropriate carrier/employer.

• To Funeral Directors/Medical Examiners/Coroners in the event of your death.

• When required by Federal, State or Local law.

• For medical research purposes, subject to your authorization, unless a waiver of authorization has been granted by an institutional review board or privacy board .

• If you are in the United States military, national security