NOTICE OF PRIVACY PRACTICES 

We have recognized the need for a definitive understanding between the patient and the physician in regards to how medical information about you may be used and disclosed, and how you can obtain access to this information. This policy will be in effect and ongoing as of August 1, 2008 

Each time you visit Surgical Specialists of Bowling Green, LLC, Dr. Bielefeld or Dr. Tamlyn, we make a record of the information gathered during your visit. This information is used for a number of purposes. These uses, your rights, and our responsibilities regarding this information are set forth below. 

USES AND DISCOLSURES OF HEALTH INFORMATION 

We are permitted by law to use your health information to provide treatment to you. We also provide this information to subsequent health care providers that we refer you to or you were referred from. 

We are permitted by law to use your health information to obtain payment for our services. 

We are permitted, and in some cases, required by law to make certain other disclosure of health information without your consent. Such disclosures include public health agencies, health oversight agencies, any individual when ordered by a court or other legal process to do so, law enforcement officials when necessary and required by law, or in the case of an emergency. 

We will not use your information for any other purposes without your written consent. 

YOUR INDIVIDUAL RIGHTS 

You have the right to obtain a paper copy of this notice or the full written privacy policy. 

You have the right to inspect and copy your health information. 

You have the right to request amendments to your health information you believe to be inaccurate. 

You have the right to request restrictions on our permitted uses and disclosures of your information (although we are not legally obligated to honor this request). 

You have the right to request that communications regarding your health information be sent by alternative means or alternative locations. 

OUR RESPONSIBILITIES 

We are required by law to maintain the privacy of your information in accordance with this notice. We are also required to provide you with this notice explaining our duties and practices regarding your health information. We are required to abide by the terms of this notice. 

We reserve the right to change the content of this notice and to make new provisions regarding your protected health information We will provide you with a revised notice during your first visit after the revisions are made.