HIPAA/Patient Privacy

Please be sure to read and sign our Patient Privacy Policies and bring to your first appointment. You may also use this form to designate who we can disclose your Personal Health Information to.

Individuals may complain to FFPC and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. FFPC’s contact person for matters relating to complaints is:

Fairfax Family Practice Centers (FFPC) Privacy Official
12011 Lee Jackson Hwy., Suite 504
Fairfax, VA 22033
Attn: Ms. Lauri Rustand
 
Telephone: 703-391-2030