NOTICE OF PRIVACY PRACTICES

DMV Medical Group, LLC

P: 240-669-7496

F: 301-321-7800

Address: 10421 Motor City Dr., Ste 341334, Bethesda, MD 20817

Website: www.dmvmedgroup.com

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your Rights

You have certain rights when it comes to your health information. These include:

  • Access to Your Records: You may request an electronic or paper copy of your medical records. We will provide this within 30 days of your request and may charge a reasonable, cost-based fee.

  • Requesting Corrections: You may ask us to correct inaccurate or incomplete health information. If we deny your request, we will provide a written explanation within 60 days.

  • Confidential Communication: You may request that we contact you in a specific way (e.g., home phone, office phone, or a different mailing address). We will accommodate reasonable requests.

  • Restricting Use and Disclosure: You may request that we not use or share certain health information for treatment, payment, or operations. We may deny your request if it affects your care.

  • Opting Out of Insurance Reporting: If you pay out-of-pocket in full for a healthcare service, you can request that we do not share this information with your health insurer unless required by law.

  • Receiving an Accounting of Disclosures: You may request a list of disclosures we have made (except for treatment, payment, or healthcare operations) within the past six years. You are entitled to one free report per year; additional reports may require a reasonable fee.

  • Obtaining a Copy of This Notice: You may request a paper copy of this Notice at any time.

  • Medical Power of Attorney: If you have assigned medical power of attorney or have a legal guardian, that person may exercise your rights regarding your health information.

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint by contacting:

DMV Medical Group, LLC

10421 Motor City Dr., Ste 341334, Bethesda, MD 20817

U.S. Department of Health and Human Services Office for Civil Rights

Address: 200 Independence Avenue, S.W., Washington, D.C. 20201

Phone: 1-877-696-6775

Website: www.hhs.gov/regulations/complaints-and-appeals/index.html

We will not retaliate against you for filing a complaint.

Your Choices

You may request how we share your health information in the following circumstances:

  • Family & Caregivers: You may allow us to share information with family members, close friends, or others involved in your care.

  • Disaster Relief: You may allow us to disclose your information for disaster relief efforts.

If you are unable to express your preference (e.g., unconscious), we may disclose your information if we believe it is in your best interest or necessary to prevent serious harm.

Information We Will Not Share Without Your Consent:

We will never share your information for:

  • Marketing purposes

  • Sale of your health information

  • Most disclosures of psychotherapy notes

How We Use and Share Your Health Information

Standard Uses

  • Treatment: We use and share your health information with other healthcare professionals involved in your care.

  • Operations: We may use your health information for internal processes such as improving care and contacting you when necessary.

  • Billing & Payment: We may share your health information with your health insurance provider for billing purposes.

Other Permitted or Required Uses

We may also share your information in the following cases:

  • Public Health & Safety: Preventing disease, reporting medication reactions, reporting abuse, neglect, or domestic violence, and preventing or reducing a serious threat to health or safety.

  • Health Research: We may share data for approved medical research in compliance with privacy regulations.

  • Legal & Government Requests: We may disclose health information if required by law, including compliance audits and investigations by the Department of Health and Human Services.

  • Organ Donation: We may share health information with organ procurement organizations.

  • Death-Related Disclosures: We may provide health information to a coroner, medical examiner, or funeral director when necessary.

  • Workers’ Compensation & Law Enforcement: We may share health information for workers' compensation claims, to comply with law enforcement requests, or with health oversight agencies.

  • Legal Proceedings: We may disclose information in response to a court order or subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information (PHI).

  • We will notify you promptly in the event of a data breach that may have compromised your personal health information.

  • We will follow the duties and privacy practices described in this notice and provide you with a copy upon request.

  • We will not use or share your information for any purpose not covered in this notice unless you provide written permission. If you change your mind after providing consent, you may revoke permission in writing at any time.

Policy Changes

We reserve the right to update this notice at any time. Changes will apply to all existing health information, and the updated notice will be available in our office and on our website.

Acknowledgment & Signature

I acknowledge that I have received and reviewed the Notice of Privacy Practices from DMV Medical Group, LLC.