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Unformatted text preview: [ FORM 22 Use the top of this page for your letterhead.] Notice of Privacy Practices (Brief Version) THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Our commitment to your privacy Our practice is dedicated to maintaining the privacy of your personal health information as part of providing profes- sional care. We are also required by law to keep your information private. These laws are complicated, but we must give you this important information. This is a shorter version of the attached, full, legally required notice of privacy practices. Please talk to our privacy officer (see the end of this form) about any questions or problems. How we use and disclose your protected health information with your consent We will use the information we collect about you mainly to provide you with treatment , to arrange payment for our services, and for some other business activities that are called, in the law, health care operations. After you have read this notice we will ask you to sign a...
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- Spring '10