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SUMMARY NOTICE OF PRIVACY PRACTICES
Effective September 2013
This notice is a summary of how your protected health information is used and disclosed and how you
can obtain access to this information.
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What is this notice is a?
This notice is a form filed with the IRS to report certain information.
Who is required to file this notice is a?
Entities or individuals who meet specific criteria outlined by the IRS are required to file this notice.
How to fill out this notice is a?
The notice is filled out by providing the requested information in the designated fields.
What is the purpose of this notice is a?
The purpose of this notice is a is to report information to the IRS for compliance purposes.
What information must be reported on this notice is a?
Specific information as requested by the IRS must be reported on this notice.
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