The law requires us to
keep your medical records confidential and to provide
you with this Notice of Privacy Practices describing how
we may use and disclose your health information, including
your medical history, symptoms, examination and test results,
diagnoses and treatment plans, to carry out treatment,
payment and health care operations and for other purposes
that are allowed or required by law. It also describes
your rights to review and control the use and disclosure
of your health information.
We are required to follow the privacy practices described
in this Notice. We may change our privacy practices at
any time. The revised privacy practices will be set forth
in a revised Notice and will be effective for all health
information that we maintain at that time. Upon your request,
we will provide you with a copy of the most recent Notice.
A current copy of our Notice of Privacy Practices will
be posted in our office in a visible location at all times.
- Uses and Disclosures. The law allows us to use and
disclose your health information for treatment, payment
and health care operations. The following are examples
of such uses and disclosures:
- Treatment. We will use and disclose your health
information to individuals within our office in
order to provide, coordinate, and manage your medical
care and any related services. This includes the
use or disclosure of your health information to
aid in the coordination or management of your medical
care with a third party. For example, your health
information 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 health information will be used
or disclosed, as needed, to allow us to obtain payment
for health care services provided to you. This may
include disclosure to your health insurance plan
or carrier as they undertake certain activities
before approving or paying for medical services.
Such activities include making a determination of
eligibility or coverage for insurance benefits,
reviewing services provided to you for medical necessity,
and undertaking utilization review activities.
- Incidental Uses and Disclosures. There may also
be incidental uses or disclosures of your health
information as a result of otherwise allowed uses
and disclosures. Such uses and disclosures may occur
because they cannot reasonably be prevented. For
example, when your name is called in the waiting
room, we cannot reasonably prevent others from overhearing
your name.
- e. Other. We may use a sign-in sheet at the registration
desk where you will be asked to sign your name and
indicate your physician. We may use or disclose
your health information, as necessary, to contact
you to schedule or remind you of an appointment,
including leaving messages on your answering machine.
We may fax your health information to carry out
treatment, payment or health care operations.
We will share your health information with other
organizations that perform various activities on
our behalf such as billing or transcription services.
Whenever an arrangement between our office and another
organization involves the use or disclosure of your
health information, we will have a written contract
that contains terms that will protect the privacy
of your health information.
We may use or disclose your health information,
as necessary, to provide you with information about
treatment alternatives or other health-related benefits
and services that may be of interest to you. For
example, your name and address may be used to send
you a newsletter about our practice and the services
we offer. We may also send you information about
products or services we believe may be beneficial
to you.
We may disclose your health information to another
health care provider of yours for their health care
operations relating to their quality assessment
and improvement activities, reviewing the competence
or qualifications of their health care professionals,
or detecting or preventing health care fraud and
abuse.
We may use or disclose demographic information about
you and the dates we provided health care services
to you for the purpose of raising funds for our
organization.
We may use or disclose your health information for
marketing purposes in meetings between our physicians
and you or when we provide you with promotional
gifts of nominal value.
- Uses and Disclosures Allowed or Required by Law.
We may use or disclose your health information in the
following situations as allowed or required by law:
- Required By Law. We may use or disclose your health
information if we are legally required to do so.
We will limit the use or disclosure to that required
by such law.
- Public Health. We may disclose your health information
to a public health authority for purposes of controlling
disease, injury or disability. We may also disclose
your health information, if directed by the public
health authority, to a foreign government agency
that is collaborating with the public health authority.
- Communicable Diseases. We may disclose your health
information, if authorized by law, to a person who
may have been exposed to a communicable disease
or may otherwise be at risk of contracting or spreading
the disease or condition.
- Health Oversight. We may disclose health information
to a health oversight agency for activities authorized
by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include,
but are not limited to, government agencies that
oversee the health care system, government benefit
programs, other government regulatory programs and
entities subject to civil rights laws.
- Abuse or Neglect. We may disclose your health
information to a public health authority that is
authorized by law to receive reports of child abuse
or neglect. In addition, we may disclose your health
information to the governmental entity or agency
authorized to receive such information if we believe
that you have been a victim of abuse, neglect or
domestic violence. In this case, the disclosure
will be made consistent with the requirements of
applicable federal and state laws.
- Food and Drug Administration. We may disclose
your health information to a person or company as
required by the Food and Drug Administration ("FDA")
for purposes relating to the quality, safety or
effectiveness of FDA regulated products or activities.
- Legal Proceedings. We may disclose health information
in the course of any judicial or administrative
proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure
is expressly authorized), and in certain conditions,
in response to a subpoena, discovery request or
other lawful process.
- Law Enforcement. We may disclose health information,
so long as applicable legal requirements are met,
to law enforcement officials, for law enforcement
purposes.
- Coroners, Funeral Directors and Organ Donation.
We may disclose health information to a coroner
or medical examiner for identification purposes,
to determine cause of death or for the coroner or
medical examiner to perform other duties authorized
by law. We may also disclose health information
to a funeral director, as authorized by law, in
order to permit the funeral director to carry out
his/her duties. Health information may be used and
disclosed for cadaveric organ, eye or tissue donation
purposes.
- Criminal Activity. Consistent with applicable
federal and state laws, we may disclose your health
information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person
or the public.
- Military Activity and National Security. When
the appropriate conditions apply, we may use or
disclose health information of individuals who are
Armed Forces personnel (1) for activities deemed
necessary by appropriate military command authorities;
(2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits,
or (3) to foreign military authority if you are
a member of that foreign military services. We may
also disclose your health information to authorized
federal officials for conducting national security
and intelligence activities, including providing
protective services to the President of the United
States or others.
- Employers. We may disclose to your employer health
information obtained in providing medical services
to you at the request of your employer for purposes
of conducting an evaluation relating to medical
surveillance of the workplace or determining whether
you have a work?related illness or injury when such
medical services are needed by the employer to comply
with certain legal requirements.
- Correctional Institutions. If you are an inmate
or in legal custody, we may disclose to the correctional
institution or law enforcement official having legal
custody of you, certain health information if necessary
for health and safety purposes.
- Workers' Compensation. Your health information
may be disclosed by us as authorized to comply with
workers' compensation laws and other similar legally
established programs.
- Compliance. Under the law, we must make disclosures
of health information to the Secretary of the Department
of Health and Human Services to enable it to investigate
or determine our compliance with the requirements
of the privacy laws.
- Written Authorization. Any uses and disclosures of
your health information for purposes other than treatment,
payment and health care operations, or as otherwise
allowed or required by law as described above will be
made only with your written authorization. Any authorization
you provide to us is effective for the period specified
in the authorization (which cannot exceed one year)
unless you revoke the authorization in writing. Any
written authorization may be revoked by you, at any
time. Your revocation shall not apply to those uses
and disclosures we made on your behalf pursuant to your
authorization prior to the time we received your written
revocation. We will accept authorizations by facsimile
and will treat such as originals.
- Others Involved in Your Healthcare. We may disclose
to a member of your family, a relative, a close friend
or any other person you identify, your health information
that directly relates to that person's involvement in
your health care or who has responsibility for payment
of your health care. We may also use or disclose your
health information to notify or assist in notifying
a relative or any person responsible for your care,
of your location, general condition or death. In addition,
we may use or disclose your health information to a
public or private entity, authorized by law or by its
charter to assist in disaster relief efforts, for the
purposes of coordinating the above uses and disclosures
to your family or other individuals involved in your
health care.
- Your Rights. Following is a statement of your legal
rights with respect to your health information and a
brief description of how you may exercise these rights.
- Access. You have the limited right, subject to
certain grounds for denial, to look at all of your
health information that we keep except for the following
records: psychotherapy notes; information compiled
in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding;
and certain laboratory information restricted by
federal law. You also have the limited right, subject
to certain grounds for denial, to obtain copies
of that health information you have a right to look
at. Our office may charge you a reasonable fee for
copying, mailing, labor and supplies associated
with your request. Any request for access to or
copies of your health information must be in writing
and provided to our Privacy Officer. If your request
for access to or copies of your health information
is denied, you may, depending on the circumstances,
have a right to have a decision to deny access reviewed.
We will provide you, in writing, with our reasons
for denial of access and, if, by law, you are allowed
to have such denial reviewed, we will provide you
with instructions for having a denial of access
reviewed.
- Restrictions. You may ask us to restrict the use
or disclosure of any part of your health information
to carry out treatment, payment or healthcare operations.
You may also request that any part of your health
information not be disclosed to family, relatives
or friends who may be involved in your care or to
notify them of your location, general condition
or death. In addition, you may request that we restrict
the use and disclosure of your health information
for disaster relief efforts. Your request must be
in writing, addressed to our Privacy Officer and
state the specific restriction requested and to
whom you want the restriction to apply. If you are
not present or able to express an objection or request
a restriction to such use or disclosure, then your
physician may, using the physician's professional
judgment, determine whether the use or disclosure
is in your best interest.
We are not required to agree to a restriction that
you may request. If your physician believes it is
in your best interest to permit use and disclosure
of your health information, your health information
will not be restricted. If your physician does agree
to the requested restriction, we may not use or
disclose your health information in violation of
that restriction unless there is an emergency. We
may terminate our agreement to restrict uses and
disclosures of your health information by providing
you with written notice of such; provided, however,
that our termination shall only be effective with
respect to health information created or received
after we have given you notice of termination of
the restriction.
- Confidential Communication. You have the right
to request that we send your health information
to you by alternative means or to an alternative
location. We will accommodate reasonable requests.
We may condition this accommodation by having you
sign an authorization, asking you for information
as to how payment will be handled or specification
of an alternative address or other method of contact.
We will not request an explanation from you as to
the basis for the request. Your request must be
in writing, addressed to our Privacy Officer, and
state the accommodations you are requesting.
- Amendments. You may request an amendment of your
health information that we maintain. Such request
must be in writing and provided to our Privacy Officer.
In certain cases, we may deny your request for an
amendment. If we deny your request for amendment,
you have the right to file a statement of disagreement
that will become part of your health information.
If you file a statement of disagreement, we reserve
the right to respond to your statement. You will
receive a copy of any response we make and any such
response will become part of your health information.
- Accounting of Disclosures. You have the right
to receive an accounting of certain disclosures
we have made, if any, of your health information.
This right applies to disclosures made on and after
April 14, 2003 for purposes other than (i) treatment,
payment or healthcare operations as described in
this Notice; (ii) disclosures made to you; (iii)
disclosures to a facility directory; (iv) disclosures
to family members or friends involved in your care
or for notification purposes; or (v) disclosures
pursuant to an authorization. The right to receive
this information is subject to certain exceptions,
restrictions and limitations. Your request for an
accounting must be in writing, addressed to our
Privacy Officer.
- Electronic Notice. If you receive a copy of this
Notice on our website or by e-mail, you have the
right to obtain a paper copy from us upon request.
- Complaints. You may complain to us or to the Secretary
of Health and Human Services if you believe we have
violated your privacy rights. To complain to us, you
may send our Privacy Officer a letter describing your
concerns to the address found below. We respect your
privacy and support any efforts to protect the privacy
of your health information. We will not retaliate against
you for filing a complaint.
- Privacy Officer Contact Information. If you have any
questions about this Notice, you may contact our Privacy
Officer by telephone, e-mail, facsimile, or mail at
the address set forth below. If, however, you want to
exercise any of your rights pursuant to this Notice
of Privacy Practices or have a complaint, such action
must be in writing and faxed or mailed to our Privacy
Officer at the address set forth below.
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