On your first visit, we ask for personal and medical information about your family and yourself. This information will be kept in your medical file in our office and will only be shared with your written authorization.

The insurance information and medical background that you supply us with will help us establish credit for medical services provided and give us some background on your past medical history.

Please keep us informed of any changes in your contact information in order to keep your file updated.


Any health related topics and/or links found on this site should not be used for diagnosing purposes or be substituted for medical advice. As with any new or ongoing treatment, always consult your professional healthcare providers before beginning any new treatment. It is your responsibility to research the accuracy, completeness, and usefulness of all opinions, services, and other information found on this site, and to consult with your professional health care provider as to whether the information can benefit you.

Carroll County Nephrology, PC assumes no responsibility or liability for any consequence resulting directly or indirectly for any action or inaction you may take based on or made in reliance on the information, services, or material on or linking to this site. Since medical developments occur daily, this site may contain outdated material. While Carroll County Nephrology, PC makes every reasonable effort to present current and accurate information, no guarantee of any kind is made. Carroll County Nephrology, PC is not liable for any damage or loss related to accuracy, completeness, or timeliness of any information contained on this site. Any links to external web sites are provided as a courtesy. They should not be construed as an endorsement by Carroll County Nephrology, PC of the content or views of the linked material.



This notice describes our Carroll County Nephrology, PC health care practices and that of: Any health care professional authorized to enter information into your medical record.


We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services your receive at the facility/practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the Physician.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to: Make sure that the medical information that identifies you is kept private; Give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms ofthe notice that is currently in effect.

The follow categories describe different ways that we use and disclose medical information. All of the ways we are permitted to use and disclose information will fall within one ofthe categories.

For Treatment. We may use medical information about you to provide you with treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care ofyou. For example, a doctor treating you for a broken leg may need to know ifyou have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.

For Payment. We may use and disclose medical information about you so that the treatment and services you receive at our facility may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations. We may use and disclose medical information about you for

  • To report neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contacting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only ifefforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release medical information ifasked to do so by a law enforcement official: In response to a court order, subpoena, warrant, summons or similar process;

To identify or locate a suspect, fugitive, material witness, or missing person; About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;

About a death we believe may be the result of criminal conduct;

About criminal conduct at the facility/practice; and

In emergency circumstances to report a crime; the location ofthe crime or victims; or the identity, description or location ofthe person who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations,

Inmates. If you are an inmate of a correctional Institution or under the custody ofa law enforcement official, we may release medical information about you to the correctional institute or la~ enforcement official. This release would be necessary (1) for the institution to provide you Wlth health care; (2) to protect your health and sqjety or the health and safety ofothers: or

(3) for the safety and security ofthe correctional institution.

You have the following rights regarding medical information we maintain about you: You have the right to Inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Carroll County Nephrology, Attn: Medical Records. If you request a copy oftheinformation,we maychargea fee for thecosts ofcopying,mailing or other supplies associated with your request

Right to Amend. Ifyou feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the Information is kept by the office.

To request an amendment, your request must be make in writing and submitted to Carroll County Nephrology. In addition, you must provide a reason that supports your request

We may deny your request for an amendment ifit is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

Is not part ofthe medical information kept by or for the office;

Is not part ofthe information which you would be permitted to inspect, and copy; or

Is accurate and complete.

Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you.

To request this list of accounting of disclosures, you must submit your request in writing to Carroll County Nephrology, Medical Records. Your request must state a time period, which may not be longer than six years and may not include dates before February 26,2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you ofthe cost involved and you may choose to withdraw or modify yotir request at that time before any costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use to disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.

We are not required to agree to your request Ifwe do agree, we will comply with your request health care operations. These uses and disclosures are necessary to operate the health care system and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.

For Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.

Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits that may be of interest to you.

Individuals Involved in Your Care or Payment of Your Care. We may release medical information about yon to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

As Required by Law. We will disclose medical information about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.


Organ and Tissue Donation. Ifyou are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans. Ifyou are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers' Compensation. We may release medical information about yon for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability;
  • To report deaths;