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Sansaricq OBGYN P.C.
Effective Date: 11/27/2025

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. Protecting your privacy is a priority for us.

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📌 Our Responsibilities

We are required by law to:

• Maintain the privacy of your protected health information (PHI)

• Provide you with this Notice describing our legal duties and privacy practices

• Notify you if a breach occurs that may have compromised your health information

• Follow the terms of this Notice currently in effect

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📌 How We May Use and Disclose Your Health Information

We may use and disclose your PHI for the following purposes without your written authorization:

1. Treatment

To provide, coordinate, or manage your medical care.
Example: Another healthcare provider involved in your care may need your medical information.

2. Payment

To bill and receive payment from you, your insurance, or a third party.
Example: We may share information with your insurance plan to verify coverage.

3. Healthcare Operations

For internal operations such as quality assessment, licensing, and training.
Example: Reviewing the quality of care provided by our staff.

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📌 Other Uses and Disclosures Allowed or Required by Law

We may share your information for:

• Public health reporting

• Abuse or neglect reports

• Health oversight activities

• Legal proceedings

• Workers’ compensation claims

• Appointment reminders or care instructions

All disclosures follow HIPAA requirements.

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📌 Uses and Disclosures Requiring Your Written Authorization

We will not use or share your information for:

• Marketing

• Sale of your information

• Most psychotherapy notes

Unless you sign a written authorization.
You may revoke this authorization at any time in writing.

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📌 Your Rights Regarding Your Health Information

You have the right to:

1. Request a Copy of Your Medical Records

You may request paper or electronic copies. Fees may apply as permitted by law.

2. Request Corrections

If you believe information is incorrect, you may request that we correct or amend it.

3. Request Limits on How We Use or Share Your Information

We are not required to agree, but we will review your request.

4. Request Confidential Communications

You may request we contact you at a different phone number, address, or email.

5. Receive a List of Disclosures

You may request a list of times we have shared your PHI for reasons other than treatment, payment, or operations.

6. File a Complaint Without Retaliation

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

• Our office, or

• The U.S. Department of Health & Human Services

We will not punish or treat you differently for filing a complaint.

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📌 Your Choices

You may choose whether we:

• Contact you regarding appointment reminders

• Contact you about family planning or OB/GYN care instructions

• Communicate through email or voicemail

• Share information with family or caregivers, unless you object

• Allow visitors to hear your name in the office lobby

You may change these choices anytime.

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📌 Data Security

We use administrative, physical, and technical safeguards to protect your medical information, including:

• Secure electronic medical records

• Restricted access controls

• Encrypted communication systems when appropriate

• Staff HIPAA training and confidentiality agreements

While no system is completely immune from risk, we follow all required HIPAA standards for data protection.

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📌 Contact Information

If you have questions about this Notice or your rights, please contact:

Sansaricq OBGYN P.C.
524 Stanton Rd Mobile, AL 36617
251-479-0058

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📌 Acknowledgment

By receiving care at Sansaricq OBGYN P.C., you acknowledge that you have been offered access to this Notice of Privacy Practices.