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. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR AGENCY.
When it comes to your health information you have certain patient rights. This section explains your rights and some of our responsibilities to help you.
PROCESS TO RECEIVE AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you by contacting our office and signing a release form.
We will provide a copy or a summary of your health information, usually within 30 days of your request.
PROCESS TO REQUEST AN AMENDMENT TO YOUR MEDICAL RECORD
- You have the right to make a request to your physician to amend your protected health information.
- In certain cases, we may deny your request for an amendment.
- Should your request be denied you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and provide you a copy with such rebuttal.
- Please contact our Privacy Officer if you have any questions amending your medical record.
PROCESS TO REQUEST CONFIDENTIAL COMMUNICATION
- You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
- We will not request an explanation from you as to the basis for the request.
- Please make this request in writing and or by email to our Privacy Officer.
ASK US TO “LIMIT” WHAT WE USE OR SHARE
- You have the right to request a restriction of your protected health information.
- You may request us not to use, share, or disclose certain health information for treatment, payment, or health care operations.
- You may also request that any part of your protected health information not be disclosed to family members and or friends who may be involved in your care for notification purposes as described in this Notice of Privacy Practices.
- We are not required to agree to your request, and we may say “no” if it may affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
GET A LIST OF THOSE WITH WHOM WE’VE SHARED INFORMATION
- You have the right to receive an accounting (list) of certain disclosures we have made, if any, of your protected health information.
- We will include all the disclosures except for those about treatment, payment, and health care operations, as described in this Notice of Privacy Practices.
- It excludes disclosures we may have made to you if you authorized us to make the disclosure for a facility directory, to family members or friends involved in your care.
GET A COPY OF THIS PRIVACY NOTICE
You may ask for a printed paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive the notice electronically.
CHOOSE SOMEONE TO ACT FOR YOU
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE VIOLATED
You may complain if you feel we have violated your rights by contacting our office and our Privacy Officer.
You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue, S.W.
Washington, D.C. 20201
calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.