HIPPA/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
4080 Lafayette Center Drive, Suite 170
Chantilly, VA 20151
Attn: Ms. Lauri Rustand
 
Telephone: 703.766.5040