Notice of 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.
1. OUR PLEDGE REGARDING MEDICAL INFORMATION
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe
your rights and certain duties we have regarding the use and disclosure of medical information.
2. OUR LEGAL DUTY
LAW REQUIRES US TO:
1. Keep your medical information private.
2. Give you this notice describing our legal duties, privacy practices, and your rights regarding your medical information.
3. follow the terms of this notice that is now in effect.
WE HAVE THE RIGHT TO:
1. Change our privacy practice and the terms of this notice at any time, provide the changes are permitted by law.
2. Make the changes in our privacy practice and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.
NOTICE OF CHANGE TO PRIVACY PRACTICES:
1. Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
3. USES AND DISCLOSURE OF YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below, without your specific written authorization. Any specific written authorization you provide may be revoked at any time by writing to us.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to asset them in
treating you.
For Payment: We may use and disclose your medical information for payment purposes.
For Heath Care Organizations: We may use and disclose your medical information for our health care operations. This might include measuring and improving quality, evaluating the performances of employees, confuting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.
For Additional Uses and Disclosures: Facility Directory, Notifications, Disaster Relief, Fundraising, Research in Limited Circumstances, Funeral Director, Coroner, Medical Examiner, Specialized Government Functions, Court Orders and Judicial and Administrative Proceedings, Public Health Activities.
4. YOUR INDIVIDUAL RIGHTS
YOU HAVE THE RIGHT TO:
1. Look at or get copies of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You may get the form request access by sending a letter to this office. If you request copies, we will charge you $10.00 for each page, and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
2. Receive a list of all times we or our business associates shared your medical information for purposes other than treatment, payment and health care operations and other specialized exceptions.
3. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
4. Request that we communicate with you about your medical information by different means or to different locations. Your request that we communicate your medical information to you by different means and or at different locations must be made in writing to the contact person listed at the end of this notice.
5. Request that we change your medical information. We may deny your request if we did not create the information you wanted changed or for certain reasons. If we deny your request, we will pride you with written explantation. You may respond with a statement of disagreement that will be added to the information you have changed. If we accept your request to change the information, we will make the reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
6. IF you have received this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to the Privacy Office at your office.
QUESTIONS AND COMPLAINTS
If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.