Notice of Privacy Practices
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
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)
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
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.