This notice is
being provided to you as a requirement of
the federal Health Insurance Portability and
Accountability Act (HIPAA). This notice
describes how we may use and disclose your
protected health information to carry out
treatment, payment or health care operations
and for other purposes that are permitted or
required by law. It also describes your
rights to access and control your protected
health information in some cases. Your
"protected health information" means any
written and oral health information about
you, including demographic data that can be
used to identify you. This is health
information that is created in or received
by your health care provider, and that
relates to your past, present or future
physical health or condition.
Each time you
visit a hospital, physician or other
healthcare provider, a record of your visit
is made. Typically, this record contains
your symptoms, examination and test results,
diagnoses, treatment and a plan for future
care or treatment. Understanding what is in
your medical record and how your health
information is used helps you to ensure its
accuracy, better understand who, what, when,
where and why others may access your health
information, and make more informed
decisions when authorizing disclosure to
others.

1. |
How
Medical Information About You May Be
Used And Disclosed
We may use and disclose protected
health information about you to
provide you with medical treatment or
services. We may disclose this
information to doctors, nurses,
technicians, office staff or other
personnel who are involved in taking
care of you. For example, we may
disclose information to people outside
of our office when scheduling tests,
arranging consultations with other
physicians, phoning in prescriptions,
etc. |
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1.1 |
For
Treatment:
We may use and disclose protected
health information about you to
provide you with medical treatment or
services. We may disclose this
information to doctors, nurses,
technicians, office staff or other
personnel who are involved in taking
care of you. For example, we may
disclose information to people outside
of our office when scheduling tests,
arranging consultations with other
physicians, phoning in prescriptions,
etc. |
|
1.2 |
For
Payment:
We may use and disclose protected
health information to obtain
reimbursement for the health care
provided to you. We may also use this
information to obtain prior
authorization for proposed treatment
or to determine whether your plan will
cover the treatment. We will also
share this information with our
billing service as needed to
facilitate their efforts towards
reimbursement from you or your
insurance company. |
|
1.3 |
For
Healthcare Operations:
We may use and disclose protected
health information to support
functions of our practice related to
treatment and payment such as case
management and quality assurance. In
addition, we may use your health
information to evaluate staff
performance, to help us decide what
additional services we offer, and
other management and administrative
activities. |
|
1.4 |
Appointment Reminders:
We may contact you to remind you that
you have an appointment or need a
referral for an appointment. |
|
1.5 |
Treatment Issues
We may call you with test results, to
tell you about treatment options or
alternatives, or to respond to your
phone call and answer questions about
your treatment. |
|
1.6 |
Health-Related Benefits and Services
We may use and disclose medical
information to tell you about
health-related benefits, services or
medical education classes that may be
of interest to you. |
|
1.7 |
Individuals Involved in Your Care or
Payment for Your Care
Unless you object, we may disclose
your protected health information to
your family or friends or any other
individual identified by you when they
are involved in your care or the
payment for your care. We will only
disclose the protected health
information directly relevant to their
involvement in your care. |
|
1.8 |
Emergencies
We may use or disclose your protected
health information in an emergency
treatment situation. If this happens,
we will try to obtain your consent as
soon as reasonably possible after the
delivery of your treatment. |
|
1.9 |
Communication Barriers
We may use or disclose your protected
health information if we have
attempted to obtain consent from you
but are unable to do so due to
substantial communication barriers and
we determine that your consent to
receive treatment is clearly inferred
from the circumstances. |
|
1.10 |
Required
by Law
We may use or disclose your protected
health information when required by
federal, state or local law. The
disclosure will be limited to the
relevant requirements of the law. |
|
1.11 |
Public
Health Risks
We may use or disclose your protected
health information for public health
reasons in order to prevent or control
disease, injury or disability; or to
report births, deaths, suspected abuse
or neglect, non-accidental physical
injuries, reactions to medications or
problems with products. |
|
1.12 |
Communicable Diseases
We may disclose your protected health
information, if required by law, to a
person who may have been exposed to a
communicable disease or may be at risk
of contracting or spreading the
disease or condition. |
|
1.13 |
Health
Oversight Activities
We may disclose protected health
information to federal or state
agencies that oversee our activities. |
|
1.14 |
Legal
Proceedings
We may disclose protected health
information in response to a court or
administrative order or in response to
a subpoena, discovery request or other
lawful process. |
|
1.15 |
Law
Enforcement
We may release protected health
information if asked to do so by a law
enforcement official in response to a
court order, subpoena, warrant,
summons or similar process subject to
all applicable legal requirements. |
|
1.16 |
Workers
Compensation
We may disclose your protected health
information as authorized to comply
with workers' compensation laws and
other similar legally established
programs. |
|
1.17 |
Military
Activity and National Security
If you are, or were, a member of the
armed forces or part of the National
Security and Intelligence communities
we may be required by military command
or other government authorities to
release health information about you.
We may also release information about
foreign military personnel to the
appropriate foreign military
authority. |
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1.18 |
Business
Associates
There may be some services provided in
our organization through contracts
with Business Associates. Examples
include our billing services,
answering services, web services, etc.
When these services are contracted, we
may disclose some of your protected
health information to our Business
Associate so that they can perform
their job. To protect your health
information, however, we require the
Business Associate to appropriately
safeguard your information. |
|
1.19 |
Other
Uses and Disclosures of Health
Information
Other uses and disclosures of your
protected health information will be
made only with your written
authorization unless otherwise
permitted or required by law as
described above. You may revoke this
authorization at any time in writing,
except to the extent that action has
already been taken in reliance on the
use or disclosure indicated on the
authorization. |
2. |
Your
Health Information Rights
You have the right to inspect and
obtain a copy of your protected health
information. This means you may
inspect and obtain a copy of your
medical and billing records. A
reasonable copying charge may apply.
This request must be made in writing. |
|
2.1 |
Right To
Inspect And Copy Your Protected Health
Information
You have the right to inspect and
obtain a copy of your protected health
information. This means you may
inspect and obtain a copy of your
medical and billing records. A
reasonable copying charge may apply.
This request must be made in writing.
|
|
2.2 |
Right To
Request A Restriction On Uses And
Disclosures Of Your Protected Health
Information
You have the right to request a
restriction on your protected health
information. This means you may ask us
to restrict or limit disclosure of any
part of your protected health
information. 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 payment for your care.
You must state the specific
restriction requested and to whom you
want the restriction to apply.
However, this request is subject to
our approval. If the physician
believes it is in your best interest
to permit use and disclosure of your
information, it will not be
restricted. If the physician does
agree to the requested restriction, we
may not use or disclose your protected
health information unless it is needed
to provide emergency treatment. |
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2.3 |
Right To
Request To Receive Confidential
Communications
You have the right to request to
receive confidential communications
from us by alternative means or at an
alternative location. We will
accommodate reasonable requests. You
must make this request in writing and
your request must specify how or where
you wish to be contacted. We will not
ask you the reason for your request. |
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2.4 |
Right To
Request Amendments To Your Protected
Health Information
You have the right to request a
correction to your protected health
information. This means you may
request an amendment of your medical
record if you believe the health
information we have about you is
incorrect or incomplete. You must make
this request in writing. Forms are
available for this purpose and can be
obtained from us. We may deny your
request for an amendment if we feel it
is inaccurate, or if the amendment you
are requesting is part of the record
that was not created by us. If we deny
your request for amendment, you have
the right to have your request and our
denial added to your medical record. |
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2.5 |
Right To
Receive An Accounting
You have the right to receive an
accounting of disclosures of your
protected health information. This
right applies to disclosures for
purposes other than treatment, payment
or healthcare operation, or for
disclosures that occurred prior to
April 14, 2003. You must make this
request in writing and this request
must include a time frame, which may
not be longer than 6 years or may not
include dates prior to April 14, 2003. |
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2.6 |
Right To
Obtain A Paper Copy Of This Notice
You have the right to obtain a paper
copy of this notice from us. |
|
2.7 |
Right To
Register A Complaint
You have the right to register a
complaint if you feel your privacy
rights have been violated. If you
believe your privacy rights have been
violated, you may file a complaint
with our office. You may also file a
complaint with the Secretary of the
Department of Health & Human Services.
You will not be penalized for filing a
complaint. |
3. |
Changes To This Notice
We reserve the right to change this
notice and to make the revised or
changed notice effective for medical
information we already have about you
as well as any information we receive
in the future. We will post a summary
of the current notice in the office
with its effective date at the top.
You are entitled to a copy of the
notice currently in effect. This
notice will be posted on our website. |
4. |
Contacting Our Privacy Officer
Contact details for our office can be
found here. |
5. |
Effective Date
This notice is effective April 14,
2003. |