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. If you have any questions, please speak to a member of our office staff.
Our Responsibilities. We are required by law to:
Maintain the privacy and security of your protected health information (Health Information and/or PHI).
Promptly inform you if a breach occurs that may have compromised the privacy or security of your information.
Follow the duties and privacy practices described in this notice and provide you a copy of it.
Not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. If you change your mind, you must inform us of the change in writing.
Typical Uses and Disclosures: We typically use or share your Health Information in the following ways:
Treatment: We can use your Health Information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Billing and Payment: We can use and share your Health Information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
Healthcare Operations: We can use and share your Health Information to run our practice, improve your care, and contact you when necessary. Example: We use Health Information about you to manage your treatment and services.
Appointment Reminders and Health Related Benefits and Services. We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We may also use and disclose Health Information to contact you about health related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information with a person who is involved in your medical care or for payment for your care, such as a family member or close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. All of our business associations are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contracts.
Medical research. Under certain circumstances, we can use or share your Health Information for health research.
Marketing and Fundraising. Health Information may be used for fundraising communications, but you have the right to opt-out of receiving such communications. Uses and disclosures of Health Information for marketing purposes, including the sale of Health Information to third parties, require your written authorization.
Other Uses. Other uses and disclosures of Health Information not contained in this Notice may be made only with your authorization.
Required Uses and Disclosures. In certain situations, we are required to share your information in other ways – usually in ways that contribute to the public good or have a legal purpose. We have to meet many conditions in the law before we can share your information for these purposes.
Public Health and Safety. We may share Health Information about you for certain situations such as: Preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to verify that we are complying with federal privacy laws.
Respond to organ and tissue donation requests. We can share Health Information about you with organ procurement organizations.
Work with a medical examiner or funeral director. We can share Health Information with a coroner, medical examiner, or funeral director when an individual dies.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authority.
Respond to lawsuits and legal actions. We can share Health Information about you in response to a court or administrative order, or in response to a subpoena.
Address workers’ compensation, law enforcement, and other government requests. We can use or share Health Information about you:
For workers’ compensation claims.
For law enforcement purposes or with a law enforcement official, when certain conditions are met.
With health oversight agencies for activities authorized by law.
For special government functions such as military, national security, and presidential protective services.
Your Rights. When it comes to your Health Information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Inspect and copy your medical record.
You can ask to see or receive an electronic or paper copy of your medical record and other Health Information we have about you. Ask us how to do this.
We will provide a copy or a summary of your Health Information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to amend your medical record.
You can ask us to amend Health Information about you that you think is incorrect or incomplete. Ask us how to do this.
We will review your request and provide a response in writing within 60 days.
Request confidential communications.
You can ask us to contact you in a specific way (for example, at home or office) or to send mail to a different address. Ask us how to do this.
We will accommodate all reasonable requests.
Ask us to limit what we use or share.
You can ask us not to use or share certain Health Information for treatment, payment, or our operations. We are not required to agree to your request, and may not agree if it would affect your care. Even if we do, we may not follow your request in the event of emergency treatment.
You have the right to request a limit on the Health Information we share with someone involved in your care or the payment for your care, such as a family member or friend.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree unless a law requires us to share that information.
These requests must be made in writing. Ask us how.
Get a list of those with whom we have shared information. You can ask for an accounting of certain disclosures of your Health Information for six years prior to the date you ask, who we shared it with, and why. The accounting does not include disclosures for treatment, payment, healthcare operations, or disclosures for which you provided written authorization.
Get a copy of this privacy notice: You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your Health Information. We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be penalized for filing a complaint.
Changes to the Terms of this Notice. We have the right to change this notice and make the new notice apply to Health Information we already have as well as any we receive in the future. We will post a copy of our current notice at our office. The notice will have the effective date on page one.