Notice of Privacy Practices
The following describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
Our practice is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. Our practice is required by law to abide by the terms of this Notice.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare 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. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.
We may change the terms of our notice at any time. The new Notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. To request a revised Notice, you may call the office and request that a revised copy be sent to you in the mail, or ask for one at the time of your next appointment.
How We May Use and Disclose Your Medical Information
We will use your medical information as part of rendering patient care. For example, your medical information may be used by the doctor or technician treating you, by the business office to process your payment for activities of the practice, including, but not limited to, use by administrative personnel reviewing the quality of the care you receive, employee review activities, training of medical students, licensing, contacting or arranging for other business activities.
We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:
Appointment Reminders and Marketing
We may contact you to provide appointment reminders. We may, on occasion, send you information regarding treatment alternatives, health-related benefits and services that may be of interest to you.
Treatment
We will record in your chart information obtained to determine your course of treatment. We may disclose your protected health information to another healthcare provider who may become involved in your care at the request of your physician.
Payment
We may bill you or a third party payer for services rendered. Identifying information may be included in that billing, along with your diagnosis and procedures.
Healthcare Operations
We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting area when your doctor is ready to see you. At times, other patients may inadvertently overhear conversations between you and your healthcare professional due to the design of the facility and need for ease of access. We make every effort to keep incidental disclosure to a minimum. Please let us know if you are uneasy in any treatment area. We may list your surname on a dispensing tray, which may be exposed to public view. In all instances, we will use the minimum amount of information necessary.
Family and Friends
Unless you object, we may disclose your medical information to family members, other relatives or close personal friends when the medical information is directly relevant to that person’s involvement with your care.
Notification
Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care of your location, general condition or death.
Disaster Relief
We may disclose your medical information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.
Health Oversight Activities
We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.
Abuse or Neglect
We may disclose your medical information when it concerns abuse, neglect or violence to you in accordance with federal and state law.
Legal Proceedings
We may disclose your medical information in the course of certain judicial or administrative proceedings.
Law Enforcement
We may disclose your medical information for law enforcement purposes or other specialized governmental functions.
Correctional Institution
Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof, health information necessary for your health and the health and safety of other individuals.
Coroners, Medical Examiners and Funeral Directors
We may disclose your medical information to a coroner, medical examiner or a funeral director.
Organ Donation
If you are an organ donor, we may disclose your medical information to an organ donation and procurement organization.
Disclosure to Department of Health and Human Services
We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.
Food and Drug Administration (FDA)
We may disclose information to the FDA relevant to adverse reactions in regards to supplements, product and product defects to allow for recalls or replacement.
Research
We may use or disclose your medical information for certain research purposes if an institutional review board or a privacy board has altered or waived individual authorization, the review is preparatory to research or the research is only on decedent information.
Public Safety
We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or to the public.
Workers’ Compensation
We may disclose your medical information as authorized by laws relating to workers’ compensation or similar programs.
Business Associates
We may disclose your health information to a business associate with whom we contract to provide services on our behalf. To protect your health information, we require our business associates to appropriately safeguard the health information of our patients.
Authorizations
We will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time.
Your Rights Regarding Your Medical Information
- You have the following rights, with respect to your medical information:
- You may ask us to restrict certain uses and disclosures of your medical information. We are not required to agree to your request, but if we do agree, we will honor the request.
- You have the right to receive communications from us in a confidential manner.
- Generally, you may inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.
- You may request an amendment to your medical records. The request must be in writing and will be reviewed by a provider. We do not have to agree to your requested amendment.
- You have the right to receive an accounting of the disclosures of your medical information made by our practice during the last six years (or following April 14, 2003), except for disclosures which you authorized and certain other specific disclosure types.
- You may request a paper copy of this Notice of Privacy Practices for Protected Health Information.
- You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way. To complain to us, please contact our Privacy Officer at the address and phone number on the front of this brochure.
Revision of Notice of Privacy Practices
We reserve the right to change the terms of this Notice, making any revisions applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised Notice at our office and will make paper copies of the revised Notice of Privacy Practices available upon request.
