1015 Duff Avenue, Ames, IA 50010

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© 2019 Doran Clinic. Carefully hand crafted by SPIN.



Effective: 4/13/03

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.

We will use and disclose health information that identifies you only with your permission except for the following purposes:

For your treatment and to provide you with treatment-related health care services.

  • So that we or others may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received.

  • For health care operations so that our patients receive quality care and to operate and manage our office.

  • To contact you and to remind you that you have an appointment with us.

  • When appropriate, with a person who is involved in your medical care or payment for your care.


In the following special situations: as required by law: to avert a serious threat to health or safety; to our business associates that perform functions on our behalf or provide us with services; organ and tissue donation; as required by military command authorities; workers' compensation or similar programs; public health risks; health oversight activities; lawsuits and disputes (only if efforts have been made to tell you about the request or to obtain an order protecting the information requested); law enforcement; coroners, medical examiners, and funeral directors; national security and intelligence activities; inmates or individuals in custody; and protective services for the president and others.


You have the following rights regarding health information we have about you:

  • Right to inspect and copy.

  • Right to amend.

  • Right to an accounting of disclosures.

  • Right to request restrictions. We are not required to agree with your request.

  • Right to request confidential communication.

  • Right to a paper copy of this notice.


*To exercise any of the aforementioned rights, please forward your written request to our privacy officer, Misty Sachs, Doran Clinic for Women, 1015 Duff Avenue, Ames, IA 50010.

If you believe your privacy rights have been violated, you may file a complaint with our office by contacting our privacy officer Misty Sachs, or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.