NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
NOTICE APPLIES TO
This notice describes the practices of this office and those of:
• Any healthcare professionals authorized to enter information into your record
• All employees, staff, and other office personnel
• Any volunteers, interns, or students we allow to work with you while you are a patient of this Medical Practice
THE DUTIES OF THIS OFFICE/ORGANIZATION
This office/organization is required by law to maintain the privacy of your personal medical information and to provide you with notice of our legal duties and privacy practices with respect to that information. We are also required to abide by the terms of our current Notice of Privacy Practices.
USE AND DISCLOSE OF MEDICAL INFORMATION
This office/organization may use your medical information for treatment, payment and healthcare operations purposes.
• For treatment purposes: Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you
• For healthcare operations: To access quality and improve services, to review the qualifications and performance of our health care providers and to train our staff.
We may use your information to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.
We may use your information to contact you in an effort to raise money for this organization and its operations.
These are some disclosures of medical information that do not require your authorization.
• Those required by federal, state or local law
• To report adverse events or defects associated with products or medications
• For public health activities, such as the reporting of communicable diseases
• About victims of abuse, neglect or domestic violence
• To comply with government oversight activities, such as audits or investigations
• To law enforcement purposes such as when we receive a subpoena, court order, or other legal process or you are the victim of a crime
• For organ or tissue purposes
• To the Food and Drug Administration relating to problems with food, supplements, and products
• For Workers Compensation
Other uses and disclosures of your medical information will be made only with your specific written authorization, which you may revoke any time by giving written notice.
You have the following rights regarding the medical information we maintain about you;
• Receive, read and ask questions about this Notice
• Ask us to restrict certain uses and discloses
• Request and receive from us a paper copy of this Notice
• Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing.
• Ask us to change your health information. You may give us this request in writing.
• When you request, we will give you a list of disclosures of your health information. You may receive this information without charge once every 12 months; any additional requests may be subject to a reasonable fee.
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released.
NOTIFICATION OF FAMILY AND OTHERS
Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may tell your family or friends your condition and that you are in a hospital. You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions about this Notice, please contact our Privacy Officer
Christine Crawford, Office Manager
We reserve the right to change our health information practices and the terms of our Notice of Privacy Practices, and to make the changes effective for all protected health information we maintain, including health information created or received before the effective date of the changes. In the event we change our health information practices, we will post and/or personally provide a revised Notice of Privacy Practices.
April 1, 2003