Medical Record Privacy

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.

Your medical record is the property of Middleton Family Medicine. There is a law that prevents us from releasing any health information without written consent of the client or parent/legal guardian if the client is under 18 years of age.

Another law requires specific signed informed consent for release of sensitive information. As custodian of your medical record, we must review your record before we copy it. If there is any mention of drugs/alcohol abuse, sexual assault, sexually transmitted disease, physical abuse, HIV, AIDS, abortion or mental health treatment, you will be required to state in writing whether you do or do not want that information released.

There are times when the law does allow the health center to share health information without consent. When such information is used to facilitate treatment, payment, health care operations, law enforcement needs, emergency care, public health needs, judicial proceedings, national security issues, or determination of cause of death.

You have the right to file a complaint with Middleton Family Medicine at any time if you think that your privacy rights have been violated.

In order to obtain or release information from your health records, please use the Authorization Form and fax it to the health center at 978-998-8004.