This notice describes your rights under the HIPAA Privacy Rules and how your medical information may be used and disclosed by us. Please review this information carefully. Please contact us at the address listed below to obtain a written copy of this Notice.
Federal and State Laws require us to protect and maintain the privacy of your “protected health information” (as that term is defined by HIPAA). Our office is required to comply with the privacy practices established in this notice which are effective as of __________. Our office reserves the rights to change these privacy practices and a new notice concerning any changes will be provided on this website and as mandated by applicable law. You have the right to request a copy of our Notice of Privacy Practices at any time and may do so by contacting us at the address and telephone number set forth below.
Use and Disclosure of Your Protected Health Information:
Your Protected Information will be used for treatment, payment, and other healthcare operations. Some examples of the circumstances under which your protected health information may be used or disclosed include (but are not limited to) the following:
- We may disclose your protected healthcare information in furtherance of your treatment. These disclosures may include providing your protected health information to other physicians who may be treating you, specialists, laboratories, and home health agencies that provide care to you or any other healthcare provider which is assisting you with any healthcare diagnosis or treatment.
- We may use your protected healthcare information for in-house business and operational activities like, quality assessments, employee reviews, training, licensing, etc.
- We will also use your protected healthcare information to obtain payment for your healthcare services. Primarily this will include sharing your protected healthcare information with your health insurance plan provider to determine eligibility for coverage, approval for hospital stays, the necessity of services, and utilization review activities. Your protected healthcare information will also be shared with third party “business associates” who provide services to our practice including billing and transcription services. We will require all business associates to enter written contracts which protect your privacy and health information.
- Your protected healthcare information may be used to provide you with information regarding treatment alternatives, health related benefits or marketing activities such as sending you a newsletter about our services or changes to our practice which may benefit you. You have the right to request that these materials not be sent to you.
- You have the right to submit a written authorization to us to request that your protected healthcare information be provided to a third party for any purpose. This may include a family member, attorney, close friend, or personal representative. We will not disclose your healthcare information except as described in the notice you provide to us. You may revoke your authorization in writing at any time.
- Your protected healthcare information may be used or disclosed for research purposes in limited circumstances such as to a coroner, protected health examiner, funeral director, or organ procurement organization for certain purposes.
- Your protected healthcare information may be disclosed to avert a serious or imminent threat to your health or safety or to the health and safety of others. This may include disclosure to a government agency authorized to oversee the healthcare system or to public health authorities for public health purposes. It may also include disclosure to a health oversight agency for activities authorized by law such as audits, investigations, and inspections.
- We may disclose your protected healthcare information when we are required to do so by law. This may include a reasonable belief that criminal activity has occurred, reports to the food and drug administration, reports of child abuse or neglect, or information required by the U.S. Department of Health and Human Services or Worker’s Compensation or similar laws.
- We may be required to disclose your protected healthcare information in response to a Court Ordered Subpoena, Administrative Order, Discovery Requests, or other lawful process of law.
Under Federal and State Laws you have the right to inspect and access both paper and electronic records of your protected healthcare information, with limited exceptions. You also have the right to obtain copies of your protected healthcare information. To do so you must make a request in writing to the contact person listed below. Our office has the right to charge a reasonable fee for reproducing, processing, and mailing your records. You may
inquire in advance as to our fee structure.
You have the right to an accounting of the disclosures made by our office or our business associates of your protected healthcare information for purposes other than treatment, payment, healthcare operations, and certain other activities. Our accounting will include the date on which the disclosure was made, the name of the person or entity who receives your protected healthcare information, a description of the protected healthcare
information disclosed, the reason for disclosure, and certain other information. We may charge you a reasonable fee if you request an accounting more than once in any twelve (12) month period.
You may request that we communicate with you in confidence about your protected healthcare information by alternative means or to an alternative location other than the original address provided to us. Your request must be in writing, must be reasonable and cannot hinder our ability to bill and collect payment from you. You may also request additional restrictions on the use of the disclosure of the protected healthcare information.
However, our office is not required to agree to these additional restrictions. Any agreement regarding additional restrictions must be in writing and if signed by all parties will be honored by our office.
You may request in writing that your protected healthcare information maintained by our office be amended. Any written request to amend your protected healthcare information must explain why the information should be amended. Your request may be denied if the information sought to be amended was not created by us or for certain other reasons. Any denial by our office will be provided to you in writing with an explanation. If any
amendment to your protected healthcare information is accepted by us we will make a reasonable effort to inform third parties to include the changes in future disclosures.
Questions and Complaints:
The address and telephone number provided below can be used to obtain more information about our privacy practices or if you have any questions or concerns. Any complaints regarding alleged violations of your privacy rights or any decisions we make regarding your privacy rights or protected healthcare information according to these privacy practices can be submitted to the address below as well. You may also submit a written
complaint to the U.S. Department of Health and Human Services whose address will be provided to you upon request.
Please be assured that our office takes your right to protect the privacy of your protected healthcare information very seriously. We will not retaliate against you in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.