This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully.

At Dr. Mahajerani's office, we have always kept your health information secure and confidential. A new law requires us to continue maintaining your privacy, to give you this notice and to follow the terms of this notice.

The law permits us to use or disclose your health information to those involved in your treatment. For example, it allows a review of your file by a specialist doctor whom we may involve in your care. We may use or disclose your health information for payment of your services. For example, we may send a report or your progress to your insurance company. We may use or disclose your health information into our computer and may share your medical information with our business office for billing purposes. We have a written contract with each billing associate that requires them to protect your privacy. We may use your information to contact you. For example, we may send newsletters or other information. We may also want to call you and remind you of your appointments. If you are not home, we may leave this information on your answering machine or with the person who answers the telephone. In an emergency, we may disclose your health information to a family member or another person responsible for your care.

We may release some or all of your health information when required by law. If this practice is sold, your information will become the property of the new owner. Except as described above, this practice will not use or disclose your health information without you prior written authorization. You may request in writing tht we not use or disclose your health information as described above. We will let yo know if we can fulfill your request. You have the right to know of any uses or disclosures we make with your health information beyond the above normal uses. As we will need to contact you from time to time we will use whatever address or telephone number you prefer. You have the right to see and recive a copy of your health information, with a few exceptions. Give us a written request regarding the information you want. If you also want a copy of your records, we may charge you a small fee for the copies. You have the right to request an amendment to your health information. Please let us know in writing. If we agree to an amendment, we will not remove any earlier documentation, but will add the new information.

If we alter any of this notice, we will contact you in writing. You may file a complaint with the Department of Health and Human Services at 200 Independence Ave., S.W., Room 509, Washington, DC 20201. However, before filing a complaint, please contact Dr. Mahajerani at 408-281-3926.
This notice goes into effect October 10, 2003.