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Do you have any of these Symptom
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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.
_____________________________________________________________
The Health Insurance
Portability & Accountability Act of 1996 ("HIPAA")
is a federal program that requires that all
medical records and other individually
identifiable health information used or
disclosed by us in any form, whether
electronically, on paper. or orally, are
kept properly confidential. This Act gives
you, the patient. significant new rights to
understand and control how your health
Information Is used. "HIPAA" provides
penalties for covered entities that misuse
personal health Information.
.As required by “HIPAA", we have prepared
this explanation of how we are required to
maintain the privacy of your health
information and how we may use and disclose
your health information.
We may use and disclose your medical records
only for each of the following purposes;
1) Treatment, 2) Payment and 3) Health care
operations.
- Treatment means providing, coordinating,
or managing health care and related services
by one or more health care providers. An
example of this would include a physical
examination. .
- Payment means such activities as obtaining
reimbursement for services, confirming
coverage, billing or collection activities,
and utilization review. An example of this
would be sending a bill for your visit to
your Insurance company for payment.
- Health care operations include the
business aspects of running our practice,
such as conducting quality assessment and
Improvement activities, auditing functions,
cost-management analysis, and customer
service. An example would be an Internal
quality assessment review.
We may also create and distribute
de-identified health information by removing
all references to individually identifiable
information.
We may contact you to provide appointment
reminders or information about treatment
alternatives or other health-related
benefits and services that may be of
interest to you.
Any other uses and disclosures will be made
only with your written authorization. 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 relying on
your authorization.
You have the following rights with respect
to your protected health information, which
you can exercise by presenting a written
request to the Privacy Officer:
- The right to request restrictions on
certain uses and disclosures of protected
health information, including those related
to disclosures to family members, other
relatives, close personal friends, or any
other person identified by you, We are,
however, not required to agree to a
requested restriction. If we do agree to a
restriction, we must abide by it unless you
agree in writing to remove it.
- The right to reasonable requests to
receive confidential communications of
protected health information from us by
alternative means or at alternative
locations.
- The right to inspect and copy your
protected health Information.
- The right to amend your protected hearth
information.
- The right to receive an accounting of
disclosures of protected health Information.
The right to obtain a paper copy of this
notice from us upon request.
We are required by law to maintain the
privacy of your protected health information
and to provide you with notice of our legal
duties and privacy practices with respect to
protected health information.
We are required to abide by the terms of the
Notice of Privacy Practices currently in
effect. We reserve the right to change the
terms of our Notice of Privacy Practices and
to make the new notice provisions effective
for all protected health information that we
maintain. We will post and you may request a
written copy of a revised Notice of Privacy
Practices from this office.
You have recourse if you feel that your
privacy protections have been violated. you
have the right to file written complaint
with our office, or with the Department of
Health & Human Services Office of Civil
Rights, about violations of the provisions
of this notice or !he policies and
procedures of our office. We will not
retaliate against you for filing a
complaint.
Please contact the agency below for more
information regarding your rights under the
“HIIPA”:
The U.S. Department of Health & Human
Services Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
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