Privacy Notice
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW WE CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice takes effect on April 1, 2003 and remains in effect until we replace it.
OUR PLEDGE REGARDING MEDICAL INFORMATION
The privacy of your medical information is important to us. We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
OUR LEGAL DUTY
We are required by law to:
1.Make sure that medical information that identifies you is kept private.
2.Give you this notice of our legal duties and privacy practices with respect to medical information about you.
3.Follow the terms of the notice that is currently in effect.
USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information.
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 assist them in treating you.
FOR PAYMENT: We may use and disclose your medical information for payment purposes.
FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information to our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
APPOINTMENT REMINDERS: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the office.
TREATMENT ALTERNATIVES: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
HEALTH RELATED BENEFITS AND SERVICES: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
FUNDRAISING ACTIVITIES: We may use medical information about you to contact you in an effort to raise money for the office and its operations. We will limit our use and sharing to information that describes you in general, not personal, terms and the dates of your health care. In any fundraising materials, we will provide you a description of how you may choose not to receive future fundraising communications.
FACILITY DIRECTORY: Unless you notify us that you object, the following medical information about you will be placed in our facilities? directories: your name your location in our facility your condition described in general terms your religious affiliation, if any. We may disclose this information to members of the clergy or, except for your religious affiliation, to others who contact us and ask for information about you by name.
INDIVISUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are unable to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, or medical information for you.
RESEARCH: Under certain circumstances, we may use and disclose medical information about you for research purposes. Before we use or disclose medical information for research, a review board that have reviewed the research proposal and established protocols to ensure the privacy of medical information will have approved the project.
FUNERAL DIRECTOR, CORONER, AND MEDICAL EXAMINER: To help them carry out their duties, we may share the medical information of a person who has died with coroner, medical examiner, or funeral director.
MILITARY AND VETERANS: If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
WORKERS? COMPENSATION: We may release medical information about you for workers? compensation or similar programs. These programs provide benefits for work-related injuries or illness.
PUBLIC HEALTH ACTIVITIES: We may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting reactions to medications or problems with products. We may also notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
HEALTH OVERSIGHT ACTIVITIES: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court of administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
LAW INFORCEMENT: We may release medical information if asked to do so by a law enforcement official. These circumstances involve in response to a court order, to identify or locate a suspect, fugitive, material witness, or missing person, reports regarding suspected victims of crimes, reporting death, crimes on our premises, and crimes in emergencies.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
You Have a Right To:
Inspect and copy material information that may be used to make decisions about you care. To inspect and copy medical information, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associate with your request. We may deny your request to inspect and copy in certain very limited circumstances.
Request that we change your medical information. To request an amendment, your request must be made in writing. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, health care operations and other specified exceptions. To request this list, you must submit your request in writing.
Request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request restrictions, you must make your request in writing. We are not required to agree to your request. If we do agree, we will comply with your request.
Request that we communicate with you about medical matters in certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must be made in writing, and it must specify how or where you wish to be contacted.
Obtain a paper copy of this notice. You may request us in writing a copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. 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 receive in the future.
COMPLAINTS
If you believe your privacy rights have been violated, 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.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW WE CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice takes effect on April 1, 2003 and remains in effect until we replace it.
OUR PLEDGE REGARDING MEDICAL INFORMATION
The privacy of your medical information is important to us. We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
OUR LEGAL DUTY
We are required by law to:
1.Make sure that medical information that identifies you is kept private.
2.Give you this notice of our legal duties and privacy practices with respect to medical information about you.
3.Follow the terms of the notice that is currently in effect.
USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information.
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 assist them in treating you.
FOR PAYMENT: We may use and disclose your medical information for payment purposes.
FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information to our health care operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses, and credentials we need to serve you.
APPOINTMENT REMINDERS: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the office.
TREATMENT ALTERNATIVES: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
HEALTH RELATED BENEFITS AND SERVICES: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
FUNDRAISING ACTIVITIES: We may use medical information about you to contact you in an effort to raise money for the office and its operations. We will limit our use and sharing to information that describes you in general, not personal, terms and the dates of your health care. In any fundraising materials, we will provide you a description of how you may choose not to receive future fundraising communications.
FACILITY DIRECTORY: Unless you notify us that you object, the following medical information about you will be placed in our facilities? directories: your name your location in our facility your condition described in general terms your religious affiliation, if any. We may disclose this information to members of the clergy or, except for your religious affiliation, to others who contact us and ask for information about you by name.
INDIVISUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are unable to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, or medical information for you.
RESEARCH: Under certain circumstances, we may use and disclose medical information about you for research purposes. Before we use or disclose medical information for research, a review board that have reviewed the research proposal and established protocols to ensure the privacy of medical information will have approved the project.
FUNERAL DIRECTOR, CORONER, AND MEDICAL EXAMINER: To help them carry out their duties, we may share the medical information of a person who has died with coroner, medical examiner, or funeral director.
MILITARY AND VETERANS: If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
WORKERS? COMPENSATION: We may release medical information about you for workers? compensation or similar programs. These programs provide benefits for work-related injuries or illness.
PUBLIC HEALTH ACTIVITIES: We may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration for purposes of reporting reactions to medications or problems with products. We may also notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
HEALTH OVERSIGHT ACTIVITIES: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court of administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
LAW INFORCEMENT: We may release medical information if asked to do so by a law enforcement official. These circumstances involve in response to a court order, to identify or locate a suspect, fugitive, material witness, or missing person, reports regarding suspected victims of crimes, reporting death, crimes on our premises, and crimes in emergencies.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
You Have a Right To:
Inspect and copy material information that may be used to make decisions about you care. To inspect and copy medical information, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associate with your request. We may deny your request to inspect and copy in certain very limited circumstances.
Request that we change your medical information. To request an amendment, your request must be made in writing. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
Receive a list of all the times we or our business associates shared your medical information for purposes other than treatment, payment, health care operations and other specified exceptions. To request this list, you must submit your request in writing.
Request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request restrictions, you must make your request in writing. We are not required to agree to your request. If we do agree, we will comply with your request.
Request that we communicate with you about medical matters in certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. Your request must be made in writing, and it must specify how or where you wish to be contacted.
Obtain a paper copy of this notice. You may request us in writing a copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. 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 receive in the future.
COMPLAINTS
If you believe your privacy rights have been violated, 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.