Notice of Privacy Practices 



                    If you have any questions about this Notice, please contact our Privacy Officer – Jill F. Meads


  1. We understand that medical information about you and your health is personal and we are committed to protecting that information.  We create a record of the care and services you receive at Dominion Women’s Health, Inc. in order to provide you with quality care and to comply with certain legal requirements.

    This Notice of Privacy Practices describes how we may use and disclose medical information about you, including demographic information, that may identify you and your related health care services to carry out your treatment, obtain payment for our services, to perform the daily health care operations of this practice and for other purposes that are permitted or required by law.  This notice also describes your rights to access and control your medical information.

    We are required to abide by the terms of this Notice of Privacy Practices.


Changes to this Notice

  1. We may change the terms of our Notice, at any time.  The new Notice will be effective for all medical information that we maintain at that time.  Upon your request, we will provide you with any revised Notice of Privacy Practices.  To request a revised copy, you may call our office and request that a revised copy be sent to you in the mail or you may ask for one at the time of your next appointment.


How We May Use and Disclose Medical Information about You

  1. The following categories describe the different ways that the Dominion Women’s Health, Inc. may use and disclose your medical information and a few examples of what we mean.  These examples are not meant to describe every circumstance, but to give you an idea of the types of uses and disclosures that may be made by our office.  Other uses and disclosures of your medical information that are not listed or described below will be made only with your written authorization.  You may revoke this authorization, at any time, in writing, but it will not apply to any actions we have already taken.


    • For your treatment: Your medical information may be used and disclosed by us for the purpose of providing medical treatment to you or for another health care provider providing medical treatment to you.  For example, a nurse obtains treatment information about you and documents it in your medical record and the physician has access to that information.  If you require an x-ray to be taken, the x-ray technician also has access to your medical information.  In addition, your medical information may be provided to a physician to whom you have been referred or are otherwise seeing to ensure that the physician has the necessary information to diagnose or treat you.


    • To obtain payment for our services: Your medical information may be used and disclosed by us to obtain payment for your health care bills or to assist another health care provider in obtaining payment for their health care bills.  For example, we may submit requests for payment to your health insurance company for the medical services that you received.  We may also disclose your medical information as required by your health insurance plan before it approves or pays for the health care services we recommend for you.


    • For our health care operations: Your medical information may be used and disclosed by us to support our daily operations.  These health care operation activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, fundraising activities, and conducting or arranging for other business activities.  For example, we may disclose your medical information to medical school students that see patients at our office.  We may also use the medical information we have to determine where we can make improvements in the services and care we offer.


    • For the health care operations of other health care providers: We may also use your medical information to assist another health care provider treating you with its quality improvement activities, evaluation of the health care professionals or for fraud and abuse detection or compliance.  For example, we may disclose your medical information to another physician to assist in its efforts to make sure it is complying with all rules related to operating a medical practice.


    • Appointment Reminders & Related Benefits and Services: We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about product and treatment alternatives or health or beauty related benefits and services that may be of interest to you.


    • Business Associates: We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.


    • Others involved in your care: When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.


Your Rights

  1. Following is a statement of your rights with respect to your medical information and a brief description of how you may exercise these rights.

    You have the right to inspect and copy your medical information.  You may inspect and obtain a copy of your medical information that we maintain.  The information may contain medical and billing records and any other records that we use for making decisions about you.  However, under federal law, you may not inspect or copy the following records:  psychotherapy notes; information compiled related to a civil, criminal, or administrative action; and medical information that is subject to law that prohibits access to medical information in certain circumstances.  We may deny your request to inspect your medical information.   In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

    You have the right to request a restriction of your medical information.  This means you may ask us not to use or disclose any part of your medical information for the purposes of treatment, payment or health care operations.  You may also request that any part of your medical information not be disclosed to family members or friends who may be involved in your care.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

    We are not required to agree to your request.  If we agree to the requested restriction, we may not use or disclose your medical information in violation of that restriction unless it is needed to provide emergency treatment or unless we otherwise notify you that we can no longer honor your request.  With this in mind, please discuss any restriction you wish to request with your physician.  Please request all restrictions in writing to our Privacy Officer.

    You have the right to request that we accommodate you in communicating confidential medical information.  We will accommodate reasonable requests, but we may condition this accommodation by asking you for information as to how payment will be handled or other information necessary to honor your request.  Please make this request in writing to our Privacy Officer.

    You may have the right to ask us to amend your medical information.  You may request an amendment of your medical information as long as we maintain this information.  In certain cases, we may deny your request for an amendment.  If we deny your request for amendment, you have the right to file a disagreement with us and we may respond in writing to you.  Please contact our Privacy Officer if you have questions about amending your medical record.

    You have the right to receive an accounting of certain disclosures we have made, if any, of your medical information.  This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices.  It excludes disclosures we may have made pursuant to your authorization (permission), made directly to you, to family members or friends involved in your care, or for appointment notification purposes.  You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.  You may request a shorter timeframe.  The right to receive this information is subject to certain exceptions, restrictions and limitations.

    You have the right to obtain a paper copy of this notice from us. If you would like a paper copy of this notice, please request one from our Privacy Officer or request one when you are in our offices.



  1. You may complain to us if you believe your privacy rights have been violated by us.  To file a complaint, please see our Privacy Officer who will be happy to assist you. You may file a complaint with us by notifying our Privacy Officer of your complaint.  We will not retaliate against you for filing a complaint.  If you do not wish to file a complaint with us, you may contact the Secretary of Health and Human Services.


Privacy Contact

  1. If you have questions about this Notice or require additional information, please contact our Privacy Officer, Jill F. Meads at (804) 730-0800 or 8239 Meadowbridge Road, Suite A, Mechanicsville, VA  23116.  Our Privacy Officer is available during normal business hours to discuss your privacy questions, concerns or complaints.


Effective Date

  1. This notice was published and becomes effective on October 3, 2017.