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UNDERSTANDING YOUR MEDICAL RECORD/HEALTH INFORMATION 

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains 

your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often 

referred to as your "medical record." This information and other information relating to your care are referred to in this notice as 

Health Information. The doctors and staff of David J. Weber, P.C. maintain Health Information relating to the care 

you receive from us. 

The Health Information contained in your record is useful for a number of reasons. For example, this information: 

-Serves as a basis for planning your care and treatment 

-Provides a means of communication among the many health professionals who contribute to your care 

-Describes the care you received 

-Allows you, your insurance company or other third-party payer to verify that services are accurately billed 

-Allows health care professionals and organizations involved in your care to conduct treatment, payment, and operational 

activities 

-Contains information we will need to contact you about appointment reminders, treatment alternatives, or other health-related 

benefits 

Understanding what is in your record and how your Health Information is used helps you to ensure its accuracy and to better 

understand who, what, when, where, and why others may access your Health Information. This, in turn, allows you to make more 

informed decisions about its use and disclosure. 

YOUR HEALTH INFORMATION RIGHTS 

Although your Health Information at our offices is the physical property of our Practice, you have certain rights relating to this 

information. As a patient, you are generally entitled to: 

-Obtain a copy or summary of your Health Information or to inspect such information (a reasonable fee may be charged) 

-Request an amendment to your Health Information where you feel there is an error 

-Request a restriction on certain uses and disclosures of your Health Information (we will consider reasonable, appropriate 

requests, but are not obligated to agree to them) 

-Obtain an accounting of certain disclosures of your Health Information (a reasonable fee may be charged to fulfill repeated 

requests for accountings) 

-Request that communication of your Health Information made to you be made by alternative means or at alternative locations 

(for example, a certain postal address or phone number). Please be aware that it is our standard practice to use any or all of 

the information you have provided to us in order to contact you for purposes of treatment (for example, conveying test 

results), payment, and business operations (for example, scheduling appointments, providing reminders). We may use 

mailings and may leave messages on your answering machine, voice mail, or with others who may answer your phone for 

these purposes. Also, if contact information we have for you is no longer valid, we may contact other persons identified in 

your record (for example, family members, persons identified as an emergency contact) to obtain updated contact information 

on you. If you wish to limit or specify the means by which we contact you, you may request our Patient Request Form and 

return it to our Privacy Officer as provided below. You do not need to give a reason for your request. Our Practice will 

accommodate requests we determine to be reasonable 

-Revoke a previous authorization to certain uses and disclosures of your Health Information by our Practice (that you may 

have provided under a written authorization), except where actions have already been taken relating to that authorization 

To exercise any of these rights, you must submit a request in writing.  Please contact our Privacy Officer to obtain written request 

forms or to ask any questions you have regarding these rights. You can contact our Privacy Officer, Susan Weber at (901) 278-6963. 

Communications may also be sent by mail to: Privacy Officer, David J. Weber, P.C., 407 Stonewall Street, Memphis, TN 38112. 

OUR RESPONSIBILITIES 

Our Practice is required by law to take measures designed to protect the privacy of your Health Information and to provide you with 

this notice describing our privacy practices and legal duties. We are also required to abide by the terms of our current notice. We 

reserve the right to change our notice and privacy practices, and to make the new provisions effective for all protected health 

information we maintain, including your Health Information. Should our privacy practices change, we will post our revised notice at 

our offices. An updated version may also be obtained if you request a copy from our Privacy Officer or from staff during a visit to our 

offices. 

We will not use or disclose your Health Information without obtaining your written authorization except as consistent with this notice 

or as otherwise required or permitted by law (for example, in emergency treatment situations). 

Although other health care providers may provide treatment to you (for example, hospitals or other physician groups) and we may 

share your Health Information with them for treatment, payment, and certain operations purposes, we are not jointly managed with or 

owned by such providers.  They are separate entities and will have their own policies and procedures for handling your Health 

Information.