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.
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 conduction 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, or 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 1, 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
facility.
You have recourse if you feel that your privacy
protections have been violated. You have
the right to file a formal, 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 facility. We will not retaliate
against you for filing a complaint.
Please contact us for more information, by asking to
speak to our Privacy Officer or for written inquiries, note “Attention Privacy
Officer.”
For more information about HIPAA or to file a complaint:
The
Office of Civil Rights
(202) 619-0257
Toll Free: 1-877-696-6775
Revised:
March 16, 2003