Privacy Policy


Effective: 3/18/2013

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

Who will follow this policy?

All Associates and staff members of our organization will adhere to these privacy practices. All business associates with whom we share health information will also adhere to these practices.

Our pledge to you.

We understand that medical information about you is personal. We are committed to protecting your medical information and privacy. We create a record of the care and services you receive to comply with insurance and legal requirements and to document quality care. This policy applies to all of the records of your care that we maintain. We are required by law to:

  • Keep medical records about you private;
  • Give you a copy of our policy, legal duties and practices with respect to medical information about you;
  • Follow the terms of the HIPPA policy that is currently in effect.


Changes to this notice

We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. Before we make a significant change to our policies, we will change our privacy notice and post the new notice in the waiting areas and exam rooms. You can receive a copy of the current notice at any time. The effective date is listed in the first paragraph of the notice. You may also be asked to acknowledge in writing your receipt of this notice.

How we may use and disclose medical information about you…

We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part of a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare).

We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, required reporting of suspected abuse or neglect, health oversight audits or inspection, research studies, funeral arrangements and organ donation, worker's compensation purposes, and emergencies.

We also disclose medical information when required by law such as in response to a request from law enforcement, and specific circumstances, or in response to valid judicial or administrative orders.

We may also contact you for an appointment reminder or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you.

Other uses of medical information

In other situations not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision. This will not apply to information already released or information related to treatment, payment, or disclosure as required by law.

Your right regarding medical information about you.

In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend our record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that the record is accurate. If we decide not to amend the record as you request, you may appeal the decision in writing.

You have the right to a list of those instances in which we have disclosed medical information about you, other than for treatment, payment, health care operations, or in which you specifically authorized a disclosure, when you submit a written request. The request must state the time period included for the account, which must be less then a 6 year period and starting after April 14, 2003. The first disclosure list in a 12 month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any cost

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.


If you are concerned that your privacy rights may have been violated, or you disagree with a decision we have made about access to your records, you may contact our privacy officer (listed below). Under no circumstance would you be penalized or retaliated against for filing a complaint.

Privacy officer:

Georgia L. Newman M.D.
224 W. Lorain St., suite A
Oberlin, OH 44074

We appreciate your understanding in the implementation of these policies and procedures. We want to provide you with cost-effective premium medical care from our team of dedicated professionals. Please let us know if you see ways in which we can improve our service to you.