Our practice is
dedicated to maintaining your privacy. In providing care to you,
we create records regarding you and our treatment and services.
We are required by Federal Privacy Regulations, which were
created as a result of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) to show that we maintain the
confidentiality of your health information.
HIPAA gives force of law to several important concepts, which we
have always followed. We have never disclosed patient
information to any person or party without the patient's request
and permission. We have always made charts available to
patients: after all, the chart is ours, but it is about you.
Thus, HIPAA does not change the care you will receive, nor our
respect for your privacy. Our practice complies with HIPAA's
regulations.
Our practice will use or disclose your personal information only
as necessary to provide quality patient care and in our normal
business operations. We will disclose your personal health
information, with your consent, to other physicians with whom we
may work in caring for you. We will use or disclose your
personal information in order to bill and collect payment for
the services you receive from us. Our practice will also use or
disclose your personal information to contact you and remind you
of your appointments.
In order to use or disclose your personal health information for
these purposes, we are legally obliged to obtain a signed
consent. It is important that you know that you have the right
to request a restriction of the use or disclosure of your
information to only certain individuals or certain locations.
The office can provide you with an authorization form for these
restrictions.
WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION AS FOLLOWS:
I. TREATMENT: Our practice uses your personal health information to treat you. We may use the information to order tests, write prescriptions, schedule surgery and provide many other services. In the process we may disclose this information to the office staff as well as others who may assist in your care, such as a pharmacist. We may also disclose your information to family members who may be assisting in your care.
2. PAYMENT: Our practice may use and disclose your personal health information in order to bill and collect payment for the services and items you may receive from us. We may contact your health insurer or other third parties that may be responsible for such costs. We may also bill you or your family members directly for services.
3. BUSINESS OPERATIONS: Our practice may use and disclose your personal health information to operate our business. For example, we may store some of your information in our computer system for scheduling purposes.
4. APPOINTMENT REMINDERS: Our practice may use and disclose your personal health information to contact you at home or at work to remind you of appointments. We may leave a message with the person or answering machine at those locations. We may also send postcards in the mail to remind you of annual visits that are due.
5. DISCLOSURES REQUIRED BY LAW: Our practice will use and disclose your personal health information when we are required to do so by federal, state or local law.
YOUR HEALTH INFORMATION RIGHTS:
l. RIGHT TO
REQUEST CONFIDENTIAL
COMMUNICATION: You have the right to request that our practice
communicate with you in a particular manner or at a certain
location. For instance, you may ask that we contact you at home,
rather than work. In order to request a certain type of
confidential communication, you must make a written request
specifying the requested method of contact or location. A form
is available at the office.
2. RIGHT TO
REQUEST SPECIAL PRIVACY PROTECTIONS: You have the right to request a
restriction in our use or disclosure of your personal health
information for treatment, payment or business operations. You
may also restrict our disclosure to only certain individuals
involved in your care or the payment for your care, such as
family members. In order to request a restriction you must make
a written request specifying the information you wish restricted
and to whom you want the limits to apply. A form is available at
the office.
3. RIGHT TO
AUTHORIZE OTHER USES OR DISCLOSURES: You have the right to
authorize other non-routine uses of your personal health
information. This request should be made in writing listing the
information you want disclosed as well as who should receive
that information. A form is available at the office.
4. RIGHT TO
INSPECT
AND COPY: You have the right to inspect and obtain a copy of
your personal health information including medical records and
billing records. You must submit your request in writing. Our
practice will charge a fee for the costs of copying, mailing,
labor and supplies associated with your request. A form is
available at the office.
5. RIGHT TO
AMEND OR SUPPLEMENT:
You may ask us to amend your personal health information if you
believe it is incorrect or incomplete as long as the information
is kept by our practice. This request must be made in writing
with a reason that supports your request. A form is available at
the office.
6. RIGHT TO
RECEIVE A COPY OF THIS NOTICE: You are entitled to receive a paper copy of
our notice of privacy practices.
7. RIGHT TO
FILE A COMPLAINT: If you believe your privacy rights have been
violated, you may file a complaint with our practice or with the
Department of Health and Human Services in Washington, D.C.. All
complaints must be submitted in writing. A form is available at
the office.
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