HIPAA NOTICE OF OUR 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.

Uses & Disclosures of Protected Health Information  (PHI)

Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.  

Treatment: We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services.  This includes the coordination or management of your healthcare with a third party.  For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you if requested or your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.  

Payment: Your PHI will be used, as needed, to obtain payment for your healthcare services.  

Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of your physician’s practice.  These may include, but are not limited to, quality assessment activities, employee review activities, training of medical students and residents, licensing, and conducting or arranging for other business activities.  For example, we may call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.  

We may use or discuss your PHI in the following situations without your authorization.  Includes as required by law: public health issues as required by law, communicable diseases, health oversight, abuse or neglect, FDA requirements, legal proceedings, workers’ compensation, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, inmates, required uses and disclosures.  Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health & Human Services to investigate or determine our compliance with the requirements of Section 164.500.  

Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law.  

You may revoke this authorization at any time, in writing, except to the extent of your physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.    

Your Rights

You have the right to get an electronic or paper copy your PHI.  We will provide a copy or a summary of your health information within 30 days for a reasonable, cost based fee.  Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.  

You have the right to request a restriction of your PHI.  This means you may ask us to use or disclose any part of your PHI for the purposes of treatment, payment of healthcare operations.  We are not required to agree to your request if it is not reasonable.  If you pay for a service or healthcare 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 and we will say “yes” unless a law requires us to share that information. 

You may also request that any of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.  We will never share your information unless you give us written permission regarding marketing purposes and sale of your information. 

We are not required to agree to a restriction you may request.  If we believe it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted.  You then have the right to use another healthcare professional.  

You have the right to request to receive confidential communications from us by alternative means.  You can ask us to contact you in a specific way (for example, home or office phone) or to send email to a specific address.   

You may have the right to have us amend your PHI.  If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.  We will include all the disclosures except for those about treatment, payment and healthcare operations, for a reasonable cost-based fee. 

We reserve the right to change the terms of this notice and will inform you by mail of any changes.  You then have the right to object or withdraw as provided in this notice.

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us notifying our privacy contact of your complaint.  We will not retaliate against you for filing a complaint.  

You have the right to obtain a paper copy of this notice from us, upon request.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to PHI.  If you have any objections to this form, please contact us by phone at our main phone number.