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NOTICE OF PRIVACY PRACTICES
(Download the Form Notice -
Click Here)
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. You have the right to obtain a paper copy of
this Notice upon request. Patient Heafth Information Under federal
law, your patient health information is protected and confidential.
Patient health information includes information about your symptoms,
test results, diagnosis, treatment, and related medical information.
Your health information also includes payment, billing, and
insurance information.
How We Use Your Patient Health Information
We use your health information about you for treatment, to obtain
payment, and for health care operations, including administrative
purposes and evaluation of the quality of care that you receive.
Under some circumstances, we may be required to use or disclose the
information even without your permission.
Examples of Treatment, Payment, and Health Care Operations
Treatment: We will use and disclose your health
information to provide you with medical treatment or services. For
example, nurses, physicians, and other members of your treatment
team will record information in your record and use it to determine
the most appropriate course of care. We may also disclose the
information to other health care providers who are participating in
your treatment, to pharmacists who are filling your prescriptions,
and to family members who are helping with your care.
Payment: We will use and disclose your health
information for payment purposes. For example, we may need to obtain
authorization from your insurance company before providing certain
types of treatment. We will submit bills and maintain records of
payments from your health plan.
Health Care Operations: We will use and disclose your
health information to conduct our standard internal operations,
including proper administration of records, evaluation of the
quality of treatment, and to assess the care and outcomes of your
case and others like it.
Special Uses
We may use your information to contact you with appointment
reminders. We may also contact you to provide information about
treatment alternatives or other health-related benefits and services
that may be of interest to you.
Other Uses and Disclosures
We may use or disclose identifiable health information about you for
other reasons, even without your consent. Subject to certain
requirements, we are permitted to give out health information
without your permission for the following purposes:
Required by Law
We may be required by law to report gunshot wounds, suspected abuse
or neglect, or similar injuries and events.
Research: We may use or disclose information for
approved medical research.
Publlc Health Activities: As required by law, we may
disclose vital statistics, diseases, information related to recalls
of dangerous products, and similar information to public health
authorities.
Health Oversight: We may be required to disclose
information to assist in investigations and audits, eligibility for
government programs, and similar activities.
Judicial and Administrative Proceedings: We may
disclose information in response to an appropriate subpoena or court
order.
Law Enforcement Purposes: Subject to certain
restrictions, we may disclose information required by law
enforcement officials.
Deaths: We may report information regarding deaths to
coroners, medical examiners, funeral directors, and organ donation
agencies.
Serious Threat to Health or Safety: We may use and
disclose information when necessary to prevent a serious threat to
your health and safety or the health and safety of the public or
another person.
Military and Special Government Functions: If you are
a member of the Armed Forces, we may release information as required
by military command authorities. We may also disclose information to
correctional institutions or for national security purposes.
Workers’ Compensation: We may release information
about you for Worker’s Compensation or similar programs providing
benefits for work-related injuries or illness.
In any other situation, we will ask for your written authorization
before using or disclosing any identifiable health information about
you. If you choose to sign an authorization to disclose information,
you can later revoke that authorization to stop any future uses and
disclosures.
Individual Rights
You have the following rights with regard to your health
information. Please contact the person listed below to obtain the
appropriate form for exercising these rights.
Request Restrictions: You may request restrictions on
certain uses and disclosures of your health information. We are not
required to agree to such restrictions, but if we do agree, we must
abide by those restrictions.
Confidential Communications: You may ask us to
communicate with you confidentially by, for example, sending notices
to a special address or not using postcards to remind you of
appointments.
Inspect and Obtain Copies: In most cases, you have the
right to look at or get a copy of your health information. There may
be a small charge for the copies.
Amend Information: If you believe that information in your record is
incorrect, or if important information is missing. you have the
right to request that we correct the existing information or add the
missing information.
Accounting of Disclosures: You may request a list of instances where
we have disclosed health information about you for reasons other
than treatment, payment, or health care operations.
Our Legal Duty
We are required by law to protect and maintain the privacy of your
health information, to provide this Notice about our legal duties
and privacy practices regarding protected health information, and to
abide by the terms of the Notice currently in effect.
Changes in Privacy Practices
We may change our policies at any time. Before we make a significant
change in our policies, we will change our Notice and post the new
Notice in the waiting area and each examination room. You can also
request a copy of our Notice at any time. For more information about
our privacy practices, contact the person listed below.
Complaints
If you are concerned that we have violated your privacy rights, or
if you disagree with a decision we made about your records, you may
contact the U. S. Department of Health and Human Services. You will
not be penalized in any way for filing a complaint.
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