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NOTICE OF
PRIVACY PRACTICES
This
Notice describes how health information about you may be used and
disclosed and how you can get access to this information. Please review
it carefully. The
privacy of your health information is important to us. This
Notice describes how we may use and disclose your protected health
information to provide treatment, obtain payment and conduct health care
operations and for other purposes permitted or required by law. It also
describes your rights concerning your protected health information.
“Protected health information” is information about you, including
demographic information that may identify you and relates to your past,
present or future physical or mental health or condition and related
health care services. We
are required by law to follow the practices described in this Notice. We
may change the terms of this Notice at any time. The new Notice will be
effective for all protected health information we maintain at that time
including health information we created or received before we made the
changes. You
may obtain a copy of our Notice of Privacy Practices at any time by
calling our office or requesting one at your next appointment. I.
Uses and Disclosures of Protected Health Information
Treatment:
We will use and disclose your health information to provide, coordinate
and manage health care and related services for you. For example we will
disclose information to a specialist to whom you have been referred to
ensure the provider has enough information to diagnose and/or treat you.
We may also disclose information to a laboratory that, at our request,
becomes involved in your treatment. Payment: We
may use and disclose your information to obtain payment for services we
provided to you. For example we will send the necessary information to
your health or dental insurance company to obtain payment for the
treatment provided. Healthcare Operations: We
will use and disclose your health information to conduct the business
activities of this office. These activities include, but are not limited
to, quality assessment and improvement activities, review of the
performance and qualifications of employees, evaluating practitioner and
provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities. We
may use a sign-in sheet at the registration desk where you will be asked
to sign your name. We may also call you by name in the waiting room when
we are ready to begin your treatment.
We may call to remind you of an upcoming appointment and if we
are unable to reach you, we may leave a message with another member of
the household or on your voice mail. We
will share your protected health information with business associates
that perform specific functions for our practice such as billing and
transcription services. When a business arrangement of this type
requires the use of your information, we will have a written contract
with the third party to protect the privacy of your protected health
information. Others Involved in Your Health Care: We
must disclose your health information to you as described in the Patient
Rights section of this Notice. We may disclose your health information
to a family member or other person to the extent necessary to help with
your health care or with payment for your health care, but only if you
agree. If we determine it is in your best interest based on our
professional judgement or experience with common practices, we may allow
another person to pick up filled prescriptions, medical supplies, x-rays
or other forms of health information. We
may use or disclose protected health information to notify or assist in
notifying a family member, a personal representative or any other person
responsible for your care of your location, your general condition or
death. If you are present prior to the use or disclosure of your
protected health information, we will provide you with the opportunity
to object to such uses or disclosures. Finally, we may use or disclose
your protected health information to an authorized public or private
entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family members or others involved in your health care. Emergencies: In
the event of your incapacity or in emergency circumstances, we may use
or disclose your protected health information to treat you.
Uses and Disclosures of Protected
Health Information Based upon Your Written Authorization:
Other uses and disclosures of your protected health information will be
made only with your written authorization, unless otherwise permitted or
required by law as described below. You may revoke this authorization,
at any time, in writing, except to the extent that an action has already
been taken in reliance on the authorization. Other Permitted and Required Uses and Disclosures That May Be Made
Without Your Consent, Authorization or Opportunity to Object Required By Law:
We may use or disclose your protected health information to the extent
that law requires the use or disclosure. The use or disclosure will be
made in compliance with the law and will be limited to the relevant
requirements of the law. We
must make disclosures to you and, when required, to the Secretary of the
Department of Health and Human Services to investigate or determine our
compliance with the requirements of the Privacy Rule, Section 164.500
et. seq. Public Health:
We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be
made for the purpose of controlling disease, injury or disability.
Additionally, we may disclose your protected health information, if
authorized by law, to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or
spreading the disease or condition. We
may disclose protected health information to a health oversight agency
for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information include
government agencies that oversee the health care system, government
benefit programs, other government regulatory programs and civil rights
laws. Abuse or Neglect:
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or domestic
violence to the governmental entity or agency authorized to receive such
information. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws. Legal Proceedings:
We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent such disclosure is
expressly authorized), in certain conditions in response to a subpoena,
discovery request or other lawful process. Law Enforcement:
We may also disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes. These law
enforcement purposes include (1) legal processes and otherwise required
by law, (2) limited information requests for identification and location
purposes, (3) pertaining to victims of a crime, (4) suspicion that death
has occurred as a result of criminal conduct, (5) in the event that a
crime occurs on the premises of the practice, and (6) medical emergency
(not on the Practice’s premises) and it is likely that a crime has
occurred. Military Activity and National Security:
When the appropriate conditions apply, we may disclose, to military
authorities, protected health information of individuals who are Armed
Forces personnel. We may also disclose your protected health information
to authorized federal officials for conducting national security and
intelligence activities including for the provision of protective
services to the President or others legally authorized. Workers’
Compensation: we may disclose
your protected health information as authorized to comply with
workers’ compensation laws and other similar legally established
programs. Inmates:
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to
you. II. Your
Rights
Your
rights with respect to your protected health information and how you may
exercise those rights are outlined below. You have a right to obtain a copy and/or
inspect your health information: Health
information includes treatment records, billing records and any other
records used by us to make decision about your treatment. You may obtain
a form from our office to request access. A reasonable cost-based fee
will be charged for expenses such as staff time, copies and postage.
Contact us as indicated at the end of this Notice to obtain information
about our fees or if you have any questions about your access. You have a right to request a restriction
on the use and disclosure of your protected health information: You
may ask us not to use or disclose some part of your protected health
information for the purposes of treatment, payment or operations. You
may also request that we not disclose some part of your information to
family and others who may be involved in your care or for notification
purposes as otherwise described in this Notice. We are not required to
agree to the restrictions but if we do, we are obligated to abide by the
agreement except in cases of emergency. You may request a restriction by
sending your request in writing to our Privacy Contact. You have a right to request to receive
confidential communications by alternative means or at an alternative
location. We will accommodate
reasonable requests. We may also condition this accommodation by asking
you for information as to how payment will be handled or specification
of an alternative address or other method of contact. We will not
request an explanation from you as to the basis for the request. Please
make this request in writing to our Privacy Contact. You may have the right to request an
amendment to your protected health information.
You may request that we amend protected health information about you.
Your request must be in writing with an explanation as to why the
information should be amended. In certain cases, we may deny your
request for an amendment. 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. You have the right to receive an
accounting of certain disclosures we have made, if any, of your
protected health information.
This right applies to disclosures made by our Business Associates or us.
It excludes disclosures for treatment, payment or healthcare
operations as described in this Notice of Privacy Practices, to you, to
family members or friends involved in your care, for notification
purposes or as a result of an authorization signed by you. You have the
right to receive specific information regarding these disclosures that
occurred after April 14, 2003 for up to the previous 6 years. You may
request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations. If you
request an accounting more than once in a 12 month period, we will
charge you a reasonable cost-based fee for responding to the additional
request. You
have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice
electronically. ________________________________________________________________________ III. Questions
and Complaints
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