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This Notice of Privacy Practices describes how we use and
disclose your protected health information (PHI) to carry out treatment,
payment or health care operations (TPO) and for other purposes that are
permitted or required by law. It also
describes your rights to access and control your protected health
information. “Protect health information” is information about you, including
demographic information, that may identify you and
that relates to your past, present or future physical or mental health or
condition and related health care services. Uses and Disclosures of
Protected Health Information Your protected health information may be used and disclosed by
your physician, our office staff and others outside of our office that are
involved in your care and treatment for the purpose of providing health care
services to you, to pay your health care bills, to support the operation of
the physician’s practices, any other use required by law. The "minimum
necessary" rule
will be followed when
using or disclosing any protected health information. This means that only
the minimum amount of information about a resident’s health is used or
disclosed when essential to completing a given task. Treatment: We will use and disclose your protected health
information to provide, coordinate, or manage your health care and any
related services. This includes the
coordination or management of your health care with a third party. For example, we would disclose your
protected health information, as necessary, to a home health agency that
provides care to you. For example,
your protected health information may be provided to a physician to whom you
have been referred to ensure that the physician has the necessary information
to diagnose or treat you. Payment: Your protected health information will be used,
as needed, to obtain payment for your health care services. For example, obtaining approval for a
hospital stay may require that your relevant protected health information be
disclosed to the health plan to obtain approval for the admission. Healthcare Operations:
We may use or disclose, as needed, your protected health information
in order to support the business activities of your physician’s
practice. These activities include,
but are not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, and conducting or
arranging for the other business activities.
For example, we may disclose your protected health information to
medical school students that see residents at our facility. We may use or disclose your protected
health information, as necessary, to contact you to remind you of your appointment. We may use or disclose your health information in the following
situations without your authorization.
These situations include: as Required by Law, Public Health issues as
required by law, Communicable Diseases: Health Oversight: Abuse or Neglect:
Food and Drug Administration requirements: Legal Proceedings; Law
Enforcement: Coroners: Funeral Directors, and Organ Donation: Research:
Criminal Activity; Military Activity and National Security: Workers’
Compensation: Inmates: Required Uses and Disclosures; Under the law, we must
make disclosures to you and when required by the Secretary of the Department
of Health and Human Services to investigate or determine our compliance with
the requirements of Section 164-500. Other Permitted and Required Uses and Disclosures Will Be Made
Only With Your Consent, Authorization or Opportunity to Object unless
required by law. You may revoke this authorization, at any time, in writing,
except to the extent that your physician or the physician’s practice has
taken an action in reliance on the use or disclosure indicated in the
authorization. Your Rights: Following is a statement of your right with respect to your
protected health information, You have the right to inspect and copy your protected health
information. Under federal law,
however, you may not inspect or copy the following records: psychotherapy
notes: information compiled in reasonable anticipation of, or use, in a
civil, criminal, or administrative action or proceeding, and protected health
information that is subject to law that prohibits access to protect health
information. You have the right to request a restriction of your protected
health information. This
means you may ask us not to use or disclose any part of your protected health
information for the purpose of treatment, payment or healthcare
operations. You may also request that
any part of your protected health information not be disclosed to family
members or friends who may be involved in your care for notification purposes
as described in this Notice of Privacy Practices. Your request must state the specific
restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that
you may request. If your physician
believes it is in your best interest to permit use and disclosure of your
protected health information, your protected health information will not be
restricted. You then have the right to
use another Healthcare Professional. You have the right to request to receive confidential
communications from us by alternative means or at an alternative
location. You have the right to obtain
a paper copy of this notice from us, upon request, even if you agree to
accept this notice alternatively i.e. electronically. You may have the right to have your physician amend your
protected health information. If we deny
your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal. You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health information. We reserve the rights to change the terms of this notice and
will inform you by mail of any changes.
You then have the right to object or withdraw as provided in this
notice. Complaints: You may complain to us or the Secretary of Health
and Human Services if you believe your privacy rights have been violated
us. You may file a complaint with us
by notifying our privacy contact of your complaint. We will not retaliate against you for
filing a complaint. This notice was published and becomes effective on/or before April
14, 2003. We are required by law to maintain the privacy of, and provide
individuals with, this notice of our legal duties and privacy practices with
respect to protected health information.
If you have any objections to this form, please ask to speak with our
HIPAA Compliance Officer in person or by phone at (717)755-1964. |
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