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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.
Protected health information, about you, is maintained as a
record of your contacts or visits for healthcare services with
our clinic. Specifically, "protected health information"
is information about you, including demographic information
(i.e., name, address, phone, etc.), that may identify you and
relates to your past, present, or future physical or mental
health condition and related healthcare services.
We are required to follow specific rules on maintaining the
confidentiality of your protected health information, using
your information, and disclosing or sharing this information
with other healthcare professionals involved in your care and
treatment. This notice describes your rights to access and control
your protected health information. It also describes how we
follow applicable rules and use and disclose your protected
health information to provide your treatment, obtain payment
for services you receive, manage our health care operations,
and for other purposes that are permitted or required by law.
If you have any questions about this Notice, please contact
our Privacy Manager.
Your Rights Under The Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference
to your protected health information. Please feel free to discuss any
questions with our staff.
You have the right to receive, and we are required to
provide you with, a copy of this Notice of Privacy Practices.
We are required to follow the terms of this notice. We reserve
the right to change the terms of our notice at any time. If
needed, new versions of this notice will be effective for all
protected health information that we maintain at that time.
Upon your request, we will provide you with a revised Notice
of Privacy Practices if you call our office and request that
a revised copy be sent to you in the mail, or ask for one at
the time of your next appointment.
You have the right to authorize other use and disclosure.
This means you have the right to authorize or deny any other
use or disclosure of protected health information that is not
specified within this notice. You may revoke an authorization,
at any time, in writing, except to the extent that your health
care provider or our office has taken an action in reliance
on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative.
This means you may designate a person with the delegated authority
to consent to, or authorize the use or disclosure of, protected
health information.
You have the right to inspect and copy your protected
health information. This means you may inspect and
obtain a copy of protected health information about you that
is contained in your patient record.
You have the right to request a restriction of your
protected health information. This means you may ask
us, in writing, 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. In
certain cases, we may deny your request for a restriction.
You have the right to request an amendment to your protected
health information. This means you may request an amendment
of your protected health information for as long as we maintain
this information. In certain cases, we may deny your request
for an amendment.
You have the right to request disclosure accountability.
This means that you may request a listing of disclosures that
we have made, of your protected health information, to entities
or persons outside of our office other than for the purposes
of treatment, payment, healthcare operations, or a purpose authorized
by you.
How We May Use or Disclose Protected Health
Information
Following are examples of uses and disclosures of your protected
healthcare information that we are permitted to make.
Treatment - We may use and disclose your protected
health information to provide, coordinate, or manage your healthcare
and any related services. This includes the coordination or
management of your healthcare with a third party that is involved
in your care and treatment. For example, we would disclose your
protected health information, as necessary, to a pharmacy that
would fill your prescriptions. We will also disclose protected
health information to other healthcare providers who may be
involved in your care and treatment. We may also call you by
name in the waiting room when your healthcare provider 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 contact you by phone or other means to provide results
from exams or tests and to provide information that describes
or recommends treatment alternatives regarding your care. Also,
we may contact you to provide information about health related
benefits and services offered by our office.
Payment - Your protected health information
will be used, as needed, to obtain payment for your healthcare
services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for
the health care services we recommend for you such as; making
a determination of eligibility or coverage for insurance benefits,
reviewing services provided to you for medical necessity, and
undertaking utilization review activities.
Healthcare Operations - We may use or disclose,
as needed, your protected health information in order to support
the business activities of our practice. This includes, but
is not limited to, business planning and development, quality
assessment and improvement, medical review, legal services,
and auditing functions. It also includes education, provider
credentialing, certification, underwriting, rating, or other
insurance-related activities. Additionally, it includes business
administrative activities such as customer service, compliance
with privacy requirements, internal grievance procedures, due
diligence in connection with the sale or transfer of assets,
and creating de-identified information.
Other Permitted and Required Uses and Disclosures
We may also use and disclose your protected health information
in the following instances as outlined below. You have the opportunity
to agree or object to the use or disclosure of all or part of
your protected health information.
To Others Involved in Your Healthcare - Unless
you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected
health information that directly relates to that person's involvement
in your healthcare. If you are unable to agree or object to
such a disclosure, we may disclose such information as necessary
if we determine that it is in your best interest based on our
professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member,
personal representative, or any other person that is responsible
for your care, general condition, or death. If you are not present
or able to agree or object to the use or disclosure of the protected
health information, then your physician may, using professional
judgment, determine whether the disclosure is in your best interest.
In this case, only the protected health information that is
relevant to your health care will be disclosed.
As Required By Law - We may use or disclose your protected health
information to the extent that the use or disclosure is required by law.
For 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.
For Communicable Diseases - 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.
For Health Oversight - We may disclose protected health information
to a health oversight agency for activities authorized by law, such as
audits, investigations, and inspections.
In Cases of 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 in a manner that is consistent with
the requirements of applicable federal and state laws.
To The Food and Drug Administration - We may
disclose your protected health information to a person or company
required by the Food and Drug Administration to report adverse
events, to monitor product defects or problems, to report biologic
product deviations, to track products, to enable product recalls;
to make repairs or replacements, or to conduct post-marketing
surveillance, as required.
For 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.
To Law Enforcement - We may also disclose
protected health information, as long as applicable legal
requirements are met, for law enforcement purposes.
To Coroners, Funeral Directors, and Organ Donation
- We may disclose protected health information to a coroner
or medical examiner for identification purposes, determining
cause of death, or for the coroner or medical examiner to perform
other duties authorized by law. We may also disclose protected
health information to a funeral director, as authorized by law,
in order to permit the funeral director to carry out his/her
duties. Protected health information may be used and disclosed
for cadaveric organ, eye or tissue donation purposes.
In Cases of Criminal Activity - Consistent
with applicable federal and state laws, we may disclose
your protected health information, if we believe that
the use or disclosure is necessary to prevent or lessen
a serious and imminent threat to the health or safety
of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
For Military Activity and National Security -
When the appropriate conditions apply, we may use or
disclose protected health information of individuals
who are Armed Forces personnel (1) for activities deemed
necessary by appropriate military command authorities;
(2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits,
or (3) to foreign military authority if you are a member
of that foreign military service.
For Workers' Compensation - Your protected
health information may be disclosed by us as authorized to comply
with workers' compensation laws and other similar legally- established
programs.
When an Inmate - 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.
Required Uses and Disclosures - Under the law, we must make
disclosures about 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 the Privacy Rule.
Complaints
You may address complaints 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 Manager of
your complaint.
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