THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This
Notice of Privacy Practices describes how we may use and disclose
your protected health information (PHI) to carry out treatment,
payment or health care operations (TPO) and for other purposes
that are permitted or required by law. It also describes your rights
to access and control your protected health information. "Protected
health information" is information about you, including demographic
information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related
health care services. 1. Uses and Disclosures of Protected Health
Information Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by
your physician, our office staff and others outside of our office
that are involved in your care and treatment for the purpose of
providing health care services to you, to pay your health care
bills, to support the operation of the physician's practice, and
any other use required by law . Treatment: We will use and disclose
your protected health information to provide, coordinate, or manage
your health care and any related services. This includes the coordination
or management of your health care with a third party. For example,
we would disclose your protected health information, as necessary,
to a home health agency that provides care to you. For example,
your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician has
the necessary information to diagnose or treat you. Payment: Your
protected health information will be used, as needed, to obtain
payment for your health care services. For example, obtaining approval
for a hospital stay may require that your relevant protected health
information be disclosed to the health plan to obtain approval
for the hospital admission. Healthcare Operations: We may use or
disclose, as-needed, your protected health information in order
to support the business activities of your physician's practice.
These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students,
licensing, and conducting or arranging for other business activities.
For example, we may disclose your protected health information
to medical school students that see patients at our office. In
addition, we may use a sign-in sheet at the registration desk where
you will be asked to sign your name and indicate your physician.
We may also call you by name in the waiting room when your physician
is ready to see you. We may use or disclose your protected health
information, as necessary, to contact you to remind you of your
appointment. We may use or disclose your protected health information
in the following situations without your authorization. These situations
include: as Required By Law, Public Health issues as required by
law, Communicable Diseases: Health Oversight: Abuse or Neglect:
Food and Drug Administration requirements: Legal Proceedings: Law
Enforcement: Coroners, Funeral Directors, and Organ Donation: Research:
Criminal Activity: Military Activity and National Security: Workers'
Compensation: Inmates: Required Uses and Disclosures: Under the
law, we must make disclosures to you and when required by the Secretary
of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be Made
Only With Your Consent, Authorization or Opportunity to Object
unless required by law. You may revoke this authorization, at any
time, in writing, except to the extent that your physician or the
physician's practice has taken an action in reliance on the use
or disclosure indicated in the authorization. Your Rights Following
is a statement of your rights with respect to your protected health
information. You have the right to inspect and copy your protected
health information. Under federal law, however, you may not inspect
or copy the following records; psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding, and protected health information
that is subject to law that prohibits access to protected health
information. You have the right to request a restriction of your
protected health information. This means you may ask us not to
use or disclose any part of your protected health information for
the purposes of treatment, payment or healthcare operations. You
may also request that any part of your protected health information
not be disclosed to family members or friends who may be involved
in your care or for notification purposes as described in this
Notice of Privacy Practices. Your request must state the specific
restriction requested and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you
may request. If physician believes it is in your best interest
to permit use and disclosure of your protected health information,
your protected health information will not be restricted. You then
have the right to use another Healthcare Professional. You have
the right to request to receive confidential communications from
us by alternative means or at an alternative location. 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 alternatively i.e.
electronically. You may have the right to have your physician amend
your protected health information. If we deny your request for
amendment, you have the right to file a statement of disagreement
with us and 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. We reserve the right
to change the terms of this notice and will inform you by mail
of any changes. You then have the right to object or withdraw as
provided in this notice. Complaints You may complain to us or to
the Secretary of Health and Human Services if you believe your
privacy rights have been violated by us. You may file a complaint
with us by notifying our privacy contact of your complaint. We
will not retaliate against you for filing a complaint. This notice
was published and becomes effective on/or before April 14, 2003.
We are required by law to maintain the privacy of, and provide
individuals with, this notice of our legal duties and privacy practices
with respect to protected health information.
If you have any objections
to this form, please ask to speak with our HIPAA Compliance Officer
in person or by phone at our Main Phone Number.
