We
care about our patients' privacy and strive to protect
the confidentiality of your medical information at this
practice. New federal legislation requires that we issue
this official notice of our privacy practices. You have
the right to the confidentiality of your medical information,
and this practice is required by law to maintain the
privacy of that information.
This practice is required to abide by the terms of the
Notice of Privacy Practices currently in effect, and
to provide notice of its legal duties and privacy practices
with respect to protected health information. If you
have any questions about this Notice, please contact
the Privacy Officer at this practice.
Who
will follow this notice?
Any
health care professional authorized to enter information
into your medical record, all employees, staff and other
personnel at this practice who may need access to your
information must abide by this Notice. All subsidiaries,
business associates (e.g. a billing service), sites
and location of this practice may share medical information
with each other for treatment, payment purposes or heath
car operation as stated in this Notice. Except where
treatment is involved, only the minimum necessary information
needed to accomplish the task will be shared.
How
We May Use and Disclose Medical Information About You
The
following categories describe different ways that we
may use and disclose medical information without your
specific consent or authorization. Examples are provided
for each category of uses or disclosures. Not all possible
uses or disclosures are listed.
For
Treatment.
We may use medical information about you to provide
you with medical treatment or services. Example: In
treating you for a specific condition, we may need to
know if you have allergies or prior injuries or surgeries
that could influence our treatment process.
For
Payment.
We may use and disclose medical information about you
so that the treatment and services you receive from
us may be billed and payment collected from you, an
insurance company or a third party. Example: We may
need to send your protected health information, such
as your name, address, office visit date, and codes
identifying your diagnosis and treatment to your insurance
company for payment.
For
Health Care Operations.
We may use and disclose medical information about you
for health care operations to assure that you receive
quality care. Example: We may use medical information
to review our treatment and services and evaluate the
performance of our staff in caring for you.
Other
Uses or Disclosures That Can be Made Without Your Consent
or Authorization
·
As required during an investigation by law enforcement
agencies
·
To avert a serious threat to public health or safety
·
As required by military command authorities for their
medical records
·
To worker's compensation or similar programs for processing
of claims
·
In response to a legal proceeding
·
To a coroner or medical examiner for identification
of a body
·
If an inmate, to the correctional institution or law
enforcement official
·
As required by the US Food and Drug Administration (FDA)
·
Other healthcare providers treatment activities
·
Other covered entities' and providers' payment activities
·
Other covered entities' healthcare operations activities
(to the extent permitted under HIPPA)
·
Uses and disclosures required by law
·
Uses and disclosures in domestic violence or neglect
situations
·
Health oversight activities
·
Other public health activities
We
may contact you to provide appointment reminders or
information about treatment and other health related
benefits and services that may be of interest to you.
Uses
and Disclosures of Protected Health Information Requiring
Your Written Authorization
Other
uses and disclosures of medical information not covered
by this Notice or the laws that apply to us will be
made only with your written authorization. If you give
us authorization to use or disclose medial information
about your, you may revoke that authorization, in writing,
at any time. IF you revoke your authorization, we will
thereafter no longer use or disclose medical information
about you for the reasons covered by your written authorization.
We are unable to take back any disclosures we have already
made with your authorization, and we are required to
retain our records of the care we have provided you.
Your
Individual Rights Regarding:
Disclosures
and Changes to Your Medical Information
Right
to Request Restrictions.
You have the right to request a restriction or limitation
on the medical information we use or disclose about
you for treatment, payment or heath care operations
or to someone who is involved in your care or the payment
of your care. We are not required to agree to your request.
If we do agree, we will comply with your request unless
the information is needed to provide you with emergency
treatment. To request restrictions, you must submit
your request in writing to the Privacy Officer at this
practice. In your request you must tell us what information
you want to limit.
Right
to an Accounting of Non-Standard Disclosures.
You have the right to request a list of the disclosures
we made of medical information about you. To request
this list, you must submit your request in writing to
the Privacy Officer at this practice. Your request must
state the time period for which you want to receive
a list of disclosures that is no longer than six years,
and may not include dates before April 14, 2003. Your
request should indicate in what form you want the list
(example: paper or electronically). The first list you
request within a 12-month period will be free. For additional
lists, we reserve the right to charge you for the cost
of providing the list.
Right
to Amend.
If you 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. To request an
amendment, your request must be made in writing and
submitted to the Privacy Officer at this practice. In
addition you must provide a reason that supports your
request. We may deny your request for an amendment if
it is not in writing or does not include a reason to
support the request. In addition we may deny your request
if the information was not created by us, is not part
of the medical information kept at this practice, is
not part of the information which you would be permitted
to inspect and copy, or which we deem to be accurate
and complete. If we deny your request for amendment,
you have the right to file a statement of disagreement
with us. We may prepare a rebuttal to your statement
and will provide you with a copy of any such rebuttal.
Statements of disagreement and any corresponding rebuttals
will be kept on file and sent out with any future authorized
requests for information pertaining to the appropriate
portion of your record.
Your
Access to Medical Information
Right
to Inspect and Copy.
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, information compiled
for use in a civil, criminal or administrative action
or proceeding, and protected health information to which
access is prohibited by law. To inspect and copy medical
information that may be used to make decisions about
your, you must submit your request in writing to the
privacy officer at this practice. If you request a copy
of the information, we reserve the right to charge a
fee for the costs of copying, mailing or other supplies
associated with your request. We may deny your request
to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you
may request that the denial be reviewed. Another licensed
heath care professional chosen by this practice will
review your request and the denial. The person conducting
the review will not be that person who denied your request.
We will comply with the outcome of the review.
Right
to a Paper Copy of This Notice.
You have the right to a paper copy of this Notice at
any time. Even if you have agreed to receive this notice
electronically, you are still entitled to a paper copy.
To obtain a paper copy of the current Notice, please
request one in writing from the Privacy Office at this
practice.
Right
to Request Confidential Communications.
You have the right to request how we should send communications
to you about medical matters, and where you would like
those communication sent. To request confidential communication,
you must make your request in writing to the Privacy
Officer at this practice. We will not ask you the reason
for your request. We will accommodate all reasonable
requests. Your request must specify how or where you
wish to be contacted. We reserve the right to deny a
request if it imposes an unreasonable burden on the
practice.
Complaints.
If you believe your privacy rights have been violated,
you may file a complaint with the Privacy Officer at
this practice or with the Secretary of the Department
of Health and Human Services. All complains must be
submitted in writing. You will not be penalized or discriminated
against for filing a complaint.
|
