Our practice is dedicated to maintaining
your privacy. In providing care to you, we create records regarding you
and our treatment and services. We are required by Federal Privacy
Regulations, which were created as a result of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) to show that we
maintain the confidentiality of your health information.
HIPAA gives force of law to several important concepts, which we have
always followed. We have never disclosed patient information to any
person or party without the patient's request and permission. We have
always made charts available to patients: after all, the chart is ours,
but it is about you. Thus, HIPAA does not change the care you will
receive, nor our respect for your privacy. Our practice complies with
HIPAA's regulations.
Our practice will use or disclose your personal information only as
necessary to provide quality patient care and in our normal business
operations. We will disclose your personal health information, with your
consent, to other physicians with whom we may work in caring for you. We
will use or disclose your personal information in order to bill and
collect payment for the services you receive from us. Our practice will
also use or disclose your personal information to contact you and remind
you of your appointments.
In order to use or disclose your personal health information for these
purposes, we are legally obliged to obtain a signed consent. It is
important that you know that you have the right to request a restriction
of the use or disclosure of your information to only certain individuals
or certain locations. The office can provide you with an authorization
form for these restrictions.
WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION AS FOLLOWS:
I. TREATMENT: Our practice uses your personal health information to treat you. We may use the information to order tests, write prescriptions, schedule surgery and provide many other services. In the process we may disclose this information to the office staff as well as others who may assist in your care, such as a pharmacist. We may also disclose your information to family members who may be assisting in your care.
2. PAYMENT: Our practice may use and disclose your personal health information in order to bill and collect payment for the services and items you may receive from us. We may contact your health insurer or other third parties that may be responsible for such costs. We may also bill you or your family members directly for services.
3. BUSINESS OPERATIONS: Our practice may use and disclose your personal health information to operate our business. For example, we may store some of your information in our computer system for scheduling purposes.
4. APPOINTMENT REMINDERS: Our practice may use and disclose your personal health information to contact you at home or at work to remind you of appointments. We may leave a message with the person or answering machine at those locations. We may also send postcards in the mail to remind you of annual visits that are due.
5. DISCLOSURES REQUIRED BY LAW: Our practice will use and disclose your personal health information when we are required to do so by federal, state or local law.
YOUR HEALTH INFORMATION RIGHTS:
l. RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION: You have the right to
request that our practice communicate with you in a particular manner or
at a certain location. For instance, you may ask that we contact you at
home, rather than work. In order to request a certain type of
confidential communication, you must make a written request specifying
the requested method of contact or location. A form is available at the
office.
2. RIGHT TO REQUEST
SPECIAL PRIVACY PROTECTIONS: You have the right to request a restriction
in our use or disclosure of your personal health information for
treatment, payment or business operations. You may also restrict our
disclosure to only certain individuals involved in your care or the
payment for your care, such as family members. In order to request a
restriction you must make a written request specifying the information
you wish restricted and to whom you want the limits to apply. A form is
available at the office.
3. RIGHT TO AUTHORIZE
OTHER USES OR DISCLOSURES: You have the right to authorize other
non-routine uses of your personal health information. This request
should be made in writing listing the information you want disclosed as
well as who should receive that information. A form is available at the
office.
4. RIGHT TO INSPECT AND
COPY: You have the right to inspect and obtain a copy of your personal
health information including medical records and billing records. You
must submit your request in writing. Our practice will charge a fee for
the costs of copying, mailing, labor and supplies associated with your
request. A form is available at the office.
5. RIGHT TO AMEND OR
SUPPLEMENT: You may ask us to amend your personal health information if
you believe it is incorrect or incomplete as long as the information is
kept by our practice. This request must be made in writing with a reason
that supports your request. A form is available at the office.
6. RIGHT TO RECEIVE A
COPY OF THIS NOTICE: You are entitled to receive a paper copy of our
notice of privacy practices.
7. RIGHT TO FILE A
COMPLAINT: If you believe your privacy rights have been violated, you
may file a complaint with our practice or with the Department of Health
and Human Services in Washington, D.C.. All complaints must be submitted
in writing. A form is available at the office.
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