THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY
As required by Health Insurance Portability & Accountability Act of 1996 (“HIPAA”), a Federal Act, we have prepared this notice for your review so you know how we maintain the privacy of your health information and how we may use it or disclose it. HIPAA requires complete confidentiality of your medical records and other individually identifiable health information that is used or disclosed by us in any form, electronic, paper, or oral. This Act gives you, the patient, the right to understand and control how your protected health information (“PHI”) is used. HIPAA provides penalties for covered entities that misuse personal health information.
We may use and disclose your medical records only for the following purposes: treatment, payment, health care operations, and law enforcement. Treatment involves providing, coordinating, or managing health care and related services by one or more healthcare providers or pharmacies. Payment involves verifying insurance coverage, obtaining reimbursement for services, billing or collections activities, and utilization review. Health Care Operations include business aspects including but not limited to conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. We may also be legally required to disclose your PHI for law enforcement and other legitimate reasons.
You may have the following rights with respect to your PHI: You have the right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures to family members, relatives, friends, or authorized individuals. We are, however, not required to honor your request except in limited circumstances. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it. You have the right to request reasonable requests to receive confidential communication of PHI by alternate means or at alternate locations, to inspect and copy your PHI, to amend your PHI, to receive an accounting of disclosure of your PHI, to obtain a paper copy of this notice from us upon your request, to receive a copy of any amendments of this notice and to be notified if your unprotected PHI is intentionally or unintentionally disclosed. If you have paid for services “out of pocket,” in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure.
We are required by law to maintain confidentiality and privacy of your PHI and to provide you the notice of privacy practice and of our legal duties with respect to PHI. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions based on your prior authorization. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post a copy and you may request a written copy of the revised Notice of Privacy Practice from our office.
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