Same day or next day appointments may be available. Please call 540.434.7528 between 9 a.m. and 3 p.m. for immediate scheduling. To make an appointment, simply submit the form below and a member of the Client Services team will contact you promptly.

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I am available:

Monday 10 a.m. – 1 p.m.Monday 1 p.m. – 4 p.m.Monday 4 p.m. – 7 p.m.Tuesday 9 a.m. – 12 p.m.Tuesday 12 p.m. – 3 p.m.Wednesday 9 a.m. – 12 p.m.

Wednesday 12 p.m. – 3 p.m.Thursday 10 a.m. – 1 p.m.Thursday 1 p.m. – 4 p.m.Thursday 4 p.m. – 7 p.m.

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AVA Care's Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES[1]

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.

When it comes to your health information, you have certain rights.

This section explains your rights and some of our responsibilities to help you.

You can ask to see or get a paper copy of your medical record and other health information we have about you.
We will provide a copy or a summary of your health information, usually within 15 calendar days of your request.

Ask us to correct your medical record

You can ask us to correct your health information that you think is incorrect or incomplete.
We may say “no” to your request, but we will respond to your request within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those consented services for lab.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
In order to ensure this person has authority and can act for you before we take any action, you must provide us with the Power of Attorney document that authorizes your designee to act on your behalf.

File a complaint if you feel your rights are violated

- You can complain if you feel we have violated your rights by contacting us using the information at the top of this page.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
- For certain health information, you can tell us your choices about what we share

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

-Share information with your family, close friends, or others involved in your care
-Share information in a disaster relief situation
-If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

How do we typically use or share your health information?

We use or share your health information in the following ways:

1. Run our organization: We use and share your health information to run our medical clinic, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.
2. How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
3. Help with public health and safety issues: We can share health information about you for certain situations such as: preventing disease, helping with product recalls, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.
4. Do research: We can use or share your information for health research, but we will never disclose personal identifying information.
5. Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if they want to see that we are complying with federal privacy law.
6. Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, for special government functions such as military, national security, and residential protective services.
7. Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities:

- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it, if requested.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
- For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice- We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

I have read and accept AVA Care's privacy practices*