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Printable Version
NOTICE OF PRIVACY PRACTICES
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.
The Health Insurance Portability & Accountability Act of 1996
(“HIPAA”) is a federal program that requires that all medical records and other
individually identifiable health information used or disclosed by us in any
form, whether electronically, on paper, or orally, are kept properly
confidential. This Act gives you, the patient, significant new rights to
understand and control how your health information is used. “HIPAA”
provides penalties for covered entities that misuse personal health information.
As required by “HIPAA”, we have prepared this explanation of
how we are required to maintain the privacy of your health information and how
we may use and disclose your health information.
We may use and disclose your medical records only for each of
the following purposes: treatment, payment and health care operations.
·
Treatment means providing, coordinating, or managing health care and
related services by one or more health care providers. An example of this
would include a physical examination.
·
Payment means such activities as obtaining reimbursement for services,
confirming coverage, billing or collection activities, and utilization review.
An example of this would be sending a bill for your visit to your insurance
company for payment.
·
Health care operations include the business aspects of running our
practice, such as conducting quality assessment and improvement activities,
auditing functions, cost-management analysis, and customer service. An
example would be an internal quality assessment review.
We may also create and distribute de-identified health
information by removing all references to individually identifiable
information.
We may contact you to provide appointment reminders or
information about treatment alternatives or other health-related benefits and
services that may be of interest to you.
Any other uses and disclosures will be made only with your
written authorization. You may revoke such authorization in writing and we
are required to honor and abide by that written request, except to the extent
that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected
health information, which you can exercise by presenting a written request to
the Privacy Officer:
·
The right to request restrictions on certain uses and disclosures of
protected health information, including those related to disclosures to family
members, other relatives, close personal friends, or any other person identified
by you. We are, however, not required to agree to a requested restriction.
If we do agree to a restriction, we must abide by it unless you agree in writing
to remove it.
·
The right to reasonable requests to receive confidential
communications of protected health information from us by alternative means or
at alternative locations.
·
The right to inspect and copy your protected health information.
·
The right to amend your protected health information.
·
The right to receive an accounting of disclosures of protected health
information.
·
The right to obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your
protected health information and to provide you with notice of our legal duties
and privacy practices with respect to protected health information.
This notice is effective as of April 14, 2003 and we are
required to abide by the terms of the Notice of Privacy Practices currently in
effect. We reserve the right to change the terms of our Notice of Privacy
Practices and to make the new notice provisions effective for all protected
health information that we maintain. We will post and you may request a
written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections
have been violated. You have the right to file written complaint with our
office, or with the Department of Health & Human Services, Office of Civil
Rights, about violations of the provisions of this notice or the policies and
procedures of our office. We will not retaliate against you for filing a
complaint.
Please contact us for more information.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
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