NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
This notice applies to all of the records of your care generated
by this practice. This notice describes information about the privacy
practices followed by all our office personnel.
We are providing this Notice to comply with the Privacy Regulations
issued by the Department of Health and Human Services in accordance
with the Health Insurance Portability and Accountability act of
We understand that your medical information is personal to you,
and we are committed to protecting the information about you. As
our patient, we create paper and electronic medical records about
you health, our care for you, and the services and goods we provide
to you as our patient. We need this record to provide for your care
and to comply with certain legal requirements.
We are required by law to:
- make sure that the protected health information about you
is kept private
- provide you with a Notice of our Privacy Practices
- follow the conditions of this Notice that is currently in
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOUR
HEALTH WITHOUT YOURAUTHORIZATION
We may use health information about you to provide you with medical
treatment or services. Therefore we may disclose medical information
about you to doctors, nurses, technicians, or hospital personnel
who are involved in your care. We may also discuss your health
information with another doctor to assist in determining the most
appropriate care for you. The practice may need to share information
about you to others not working in our office, such as phoning
in medical prescriptions to your pharmacy, optical prescriptions
to your optician, scheduling lab work and radiological services
and scheduling surgical procedures. We also may disclose medical
information about you to people out side the practice who may
be involved in your medical care after you leave this practice;
this may include your family members, or other personal representatives
authorized by you or your legal guardian.
We may use and disclose medical information about you for services
and procedures so they may be billed and collected from you, an
insurance company, or any other third party. We may need to give
your health care information about your treatment to obtain payment
or reimbursement for the care received. We may also tell your
health plan and/or referring physician about treatment you are
going to receive to obtain prior approval or to determine whether
your plan will cover the treatment.
Health Care Operations
We may disclose medical information about you so that our practice
can be run more efficiently and make sure that all patients receive
quality care. We may use or disclose information for internal
and external utilization review or quality assurance. We shall
endeavor at all times to advise any external business associates
of their continued obligation to maintain the privacy of your
Appointment and Patient Recall Reminders
We may ask that you sign in writing at the front desk a “Sign
In” log on the day of your appointment with this practice.
We reserve the right to call you by name while in a waiting room
with other patients present, to verify information or to escort
you to an examination room. We may contact you as a reminder that
you have an upcoming appointment with this practice or to change
an existing appointment, if necessary.
We may disclose medical information about you to an organization
assisting in a disaster relief effort or in an emergency situation
so that your family can be notified about your condition, status
We may use and disclose health information about you for research
projects that are subject to a special approval process. We will
ask for your permission if a researcher will have access to your
name, address or other information that reveals personal information.
Required By Law
We will disclose medical information about you when required to
do so by federal, state or local law.
Organ and Tissue Donation
If you are an organ donor, we may release medical information
to organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary
to facilitate organ or tissue donation and transplantation.
We may release medical information about you for workers’
compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
Military, Veterans, National Security and Intelligence
If you are or were a member of the armed forces, or part of the
national security or intelligence communities, we may be required
by military command or other government authorities to release
health information about you. We may also release information
about foreign military personnel to the appropriate foreign military
Public Health Risks
Law or public policy may require us to disclose medical information
about you for public health activities. These reasons may include
to prevent or control disease, injury or disability, or report
births, deaths, suspected abuse or neglect, non-accidental physical
injuries, reactions to medications or problems with products.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose
health information about you in response to a court or administrative
order. Subject to all applicable legal requirements, we may also
disclose health information about you in response to a subpoena.
We may release medical information if asked to do so by law enforcement
officials in response to a court order, subpoena, warrant, summons
or similar process, subject to all applicable legal requirements.
Coroners, Medical Examiners and Funeral Directors
We may release health information to a coroner or medical examiner.
This may be necessary to identify a deceased person or determine
the cause of death. We may also release medical information to
funeral directors as necessary to carry out their duties.
If you are an inmate of a correctional institution or under custody
of a law enforcement official, we may release medical information
about you to a correctional institution or law enforcement official.
Family and Friends
We may disclose health information about you to your family members
or friends if we obtain your verbal agreement to do so or if you
are given opportunity to object to such a disclosure and you do
not raise an objection. We may also disclose health information
if we can infer from the circumstance, based on our professional
judgment, that you would not object. Such as bringing your spouse,
family member or friend into the examination room during treatment
or while treatment is being discussed.
OTHER USES OF MEDICAL INFORMATION
Other uses of your medical information not covered by this notice
or the laws that apply to us will be made only with your written
permission, unless those uses can be reasonably inferred from the
intended uses mentioned previously. If you have provided us with
your permission to use or disclose medical information about you,
you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose medical
information about you for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures we
have already made with your permission, and that we are required
to retain our records of the care that we provided to you.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve
the right to make the revised or changed notice effective for medical
information we already have about you as well as any information
we may receive from you in the future. We will post a copy of the
current notice in the office with the effective date in the top
right hand corner.
If you believe your privacy rights have been violated, you may file
a complaint to our office manager or with the Secretary of the Department
of Health and Human Services. All complaints must be submitted in
writing and all complaints shall be investigated, without repercussion
You have the following rights regarding medical information we maintain
Right to Inspect And Copy
You have the right to inspect and have your medical record copied.
Upon proof of an appropriate legal relationship, records of others
related to you or under your care may also be disclosed. To inspect
and copy your records, you must submit your request in writing
to our office manager. We reserve the right to charge a fee for
the copying of these records.
Right to Amend
If you feel that the medical information we have about you in
your record is incorrect or incomplete, then you may ask us to
amend the information. This request for an amendment must be submitted
in writing. We may deny your request for an amendment to be added
to the medical record if reasons are not given to support the