Mary F. Holley MD PC



Notice of Privacy Policy

Individual Rights

You have certian rights under the federal privacy standards. These include:

    • The right to request restrictions on the use and disclosure of your protected health information.
    • The right to receive confidential communications concerning your medical condition and treatment.
    • The right to inspect and copy your protected health information.
    • The right to amend or submit corrections to your protected health information.
    • The right to receive an accounting of how and to whom your protected health information has been disclosed.
    • The right to receive a printed copy of this notice.


Duties of Mary F Holley MD PC

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.

We are also required to abide by the privacy policies and practices that are outlined in this notice.

Uses and Disclosures

Treatment. Your health information (medical record) may be used by staff members and physician or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members or physicians.

Payment. Your health information (medical record) may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Healthcare operations. Your health information (medical record) may be used as necessary to support the day-to-day activities and management of Mary F Holley MD, PC. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality healthcare.

Law enforcement. Your health information (medical record) may be isclosed to law enforcement agencies to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government-mandated reporting.

Public health reporting. Your health information (medical record) may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Other uses and disclosures. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.


Additional Users of Information

Appointment reminders and notifications. Your health information will be used by our staff to send you appointment reminders or to send you notification of the results of tests or consultations. Notifications and reminders will be sent to the address, phone or e-mail address that you specify.


Right to Revise Privacy Practices

As permitted or required by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information (medical record) that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting one of the front desk personnel or the Privacy Officer.


Mary F Holley MD PC
Attn Privacy Officer
2001 Gunter Ave
Guntersville, AL 35976