THIS NOTICE DETAILS HOW YOUR MEDICAL INFORMATION WILL BE DISCLOSED AND USED. IT ALSO TALKS ABOUT HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE GO OVER IT CAREFULLY.

WHO WILL PAY ATTENTION TO THIS NOTICE?

This notice covers the procedures and practices that any of our members who handle your medical information will follow.

OUR COMMITMENT TO PROTECTING YOUR HEALTH INFORMATION

We recognize that medical information about you and your health is private to you. We are devoted to safeguarding your medical information. We keep our records and run our treatment environment to ensure the highest degree of privacy for your medical information while providing the best medical care possible. This notice applies to all records of your medical care that we receive or create.

Other medical care providers (for example, physicians, hospitals, home health agencies, and so on) may have different rules or notifications regulating the use and dissemination of your medical information.

This notice will notify you of how we may use and share medical information about you. Your medical information, commonly known as “protected health information,” is any information about you, including demographic information, that may be used to identify you and pertains to your past, present, or future physical or mental health information, as well as connected health care services.

Make certain that your medical and other identifying information (protected health information) is kept secret. Provide you with this notice of our legal obligations and privacy policies with protected health information about you. Follow the provisions of the present in effect notice.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS USE AND DISCLOSURES

By becoming our patient, you give us permission to use your protected health information for specified purposes, such as treatment, payment, and other health care operations. These three actions are sometimes referred to as “TPO.”

First and foremost, we may use and disclose protected health information about you to our medical experts to treat you. For example, we may utilize your previous medical information to diagnose your current illness, or we may disclose information about your medical condition to another doctor to whom we recommend you for further treatment. We may also use and disclose protected health information about you in order to be reimbursed for the medical care you receive. 

For example, in order to collect reimbursement for services given to you, we will disclose protected health information about you to your insurance carrier. We may also use and disclose your protected health information for health purposes.

The following uses of your protected health information are permissible without further authorization from you. 

APPOINTMENT REMINDER USES AND DISCLOSURES.

We may use and disclose your medical information to contact you in order to remind you of an upcoming appointment at the office. If you prefer that such conversations be kept private, please write to us. All reasonable demands will be accommodated.

DISCLOSURES AND USES TO THOSE ENGAGED IN YOUR HEALTHCARE

We may share protected health information that directly pertains to that individual’s involvement in your medical treatment to a member of your family, a relative, a close friend, or any other person you select. If you are unable to consent to or object to this disclosure, we may share such information as we deem necessary in your best interests based on our professional judgment.

We may also use or disclose protected health information to notify or help in alerting a family member, personal representative, or anyone else in charge of the care of your whereabouts, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private body to aid in disaster relief efforts, as well as to coordinate uses and disclosures to family members or other persons involved in your health care.

APPLICATIONS AND DISCLOSURES IN EMERGENCY SITUATIONS

In an emergency treatment scenario, we may use or disclose your protected health information. If this occurs, your physician will make every effort to acquire your acknowledgment of this Notice as soon as reasonably possible after therapy is administered.

HEALTH-RELATED BENEFITS OR SERVICES: USES AND DISCLOSURES

We may use and disclose protected health information from time to time to alert you about health-related benefits or services that may be of interest to you.

LEGALLY MANDATED USES AND DISCLOSURES

When required by federal, state, or local law, we will use or disclose protected health information about you. The use or disclosure will be done in accordance with the law and will be restricted to the necessary legal obligations. 

If the law demands it, we will notify you of any such uses or disclosures. We must make disclosures to you as required by the Secretary of Health and Human Services.

Communicable disease applications and disclosures

If permitted by law, we may release your protected health information to a person who has been exposed to a communicable illness or is otherwise at risk of getting or spreading the disease or condition.

DISCLOSURES FOR HEALTH-RELATED ACTIVITIES

We may share protected health information with a health supervision body for lawful purposes. Audits, inquiries, and inspections are examples of these actions. These tasks are required for the government to supervise the healthcare system, healthcare delivery, government benefit programs, other government regulatory programs, and civil-rights legislation.

REPORTS OF ABUSE OR NEGLECT

Your protected health information may be disclosed to a public health body authorized by law to accept allegations of child abuse or neglect. Furthermore, suppose we suspect you have been a victim of abuse, neglect, or domestic violence. In that case, we may disclose your protected health information to a governmental body or agency authorized to receive such information. In such instances, the disclosure will be done exclusively in compliance with State name legislation.

INFORMATION PROVIDED TO THE FOOD AND DRUG ADMINISTRATION

We may disclose your protected health information to a person or company required by the Food and Drug Administration (FDA) to report adverse events, product defects or other problems, biologic product deviations, track products, enable product recalls, make repairs or replacements, or conduct post-market surveillance.

DISCLOSURES IN CONNECTION WITH LITIGATION AND CONFLICTS

We may reveal protected health information about you in response to a court or administrative order if you are involved in litigation or dispute. 

INFORMATION PROVIDED TO POLICE ENFORCEMENT

If a law enforcement officer requests it, we may divulge protected health information in response to a court order, summons, or similar procedure.

Other relevant disclosures may include those relating to people serving in the Armed Forces, national security and intelligence agencies, and authorized federal authorities for the protection of the President of the United States or other authorized persons or foreign heads of state.

CORONERS’ AND FUNERAL DIRECTORS’ DISCLOSURES, AS WELL AS ORGAN DONATION

We may disclose protected health information about you to a coroner or medical examiner for the purpose of identifying you, finding the cause of death, or for the coroner or medical examiner to execute other legal tasks.

We may also disclose protected health information about you to a funeral director to allow the funeral director to carry out legal responsibilities, and we may do so if death is reasonably expected. Your protected health information may also be revealed in connection with some organ donations you may have consented to.

DISCLOSURES FOR RESEARCH PURPOSES

We may release your protected health information to researchers if their research has been approved and mechanisms to preserve the privacy of your information have been developed. We may also disclose a restricted set of personal information for research purposes, as permitted by law.

CRIMINAL ACTIVITY-RELATED DISCLOSURES

We may disclose your protected health information in accordance with federal and state name laws if we believe that the use or disclosure is required to prevent or lessen a serious or imminent threat to a person’s or the public’s health or safety or if law enforcement authorities need to identify or apprehend an individual.

WORKERS’ COMPENSATION DISCLOSURES

We may disclose protected health information about you in order to comply with Workers’ Compensation or other comparable programs. These programs offer compensation for work-related accidents or diseases.

INSPECTION AND COPYING RIGHTS

You have the right to see and copy confidential health information that may be used to make medical care decisions about you. This right often covers both medical and billing information.

Your request must be submitted in writing. If you request a copy of the material, we may charge a fee to cover the expenses of copying, mailing, or other supplies. Your request to examine and copy your information may be rejected only in very specific situations, and you have the right to have any such rejection reviewed.

RIGHT TO REQUEST LIMITATIONS

You have the right to ask us to limit the use and sharing of your protected health information for treatment, payment, and health care operations. We are not obligated to grant your request. If we agree, we will honor your request unless the information is required to assist you with emergency care.

You must submit your request for limits in writing. You must include the following information in your request:

  • What information do you wish to restrict?
  • You can restrict our usage, disclosure, or both.
  • Whom do you want the restrictions to apply to?

RIGHT TO PRIVATE COMMUNICATIONS

You also have the right to request that private health information notifications (such as appointment confirmations) be delivered to you through alternate means or at alternative locations. 

You might, for example, request that we only contact you at work or by mail. You must express your request for private conversations in writing. We shall not inquire as to the cause of your request. All reasonable demands will be accommodated. It would help to describe how and where you want to be reached in your request.

RIGHT TO REVISE

If you believe that the protected health information we have on file for you is erroneous or incomplete, you have the right to request that it be updated. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that provides the service is eligible.

RIGHT TO A DISCLOSURE ACCOUNTING

You have the right to an accounting of disclosures of your protected health information made by us or any of the persons or entities who undertake treatment, payment, or health care operations on our behalf for purposes other than treatment, payment, or health care operations. You must submit a written request to obtain this list of disclosures we made of protected health information about you. 

Your request must include a time frame that is no more than six (6) years before the date of your request and does not include days before August 1, 2005. The form you want the list should be specified in your request (for example, on paper or electronically). 

OTHER APPLICATIONS FOR PROTECTED HEALTH INFORMATION

Your protected health information’s other uses and disclosures that are not covered by this notice or the applicable laws will be made only with your express authorization.

If you give us permission to use or disclose protected health information about you, you have the right to cancel that consent in writing at any time. 

You acknowledge that we cannot retract any disclosures made with your authorization and that we are obligated to keep records of the medical treatment or other services that we have given to you.

HAVE ANY QUESTIONS?

Don’t hesitate to contact the Office Manager if you have any queries about this notification.