EFFECTIVE DATE: 10/25/2023
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
We are required by law to protect the privacy of your protected health information (“medical information”). We are also required to send you this notice about our privacy practices, our legal duties, and your rights concerning your medical information.
We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on the date set forth at the top of this page and will remain in effect unless we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make any changes in our privacy practices and the new terms of our notice applicable to all medical information we maintain, including medical information we created or received before we made the change.
We may amend the terms of this notice at any time. If we make a material change to our policy practices, we will provide you with the revised notice. Any revised notice will be effective for all health information that we maintain. The effective date of a revised notice will be noted.
A copy of the current notice in effect will be available in our facility and on our website if applicable. You may request a copy of the current notice at any time.
We collect and maintain oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our patients.
We maintain physical, electronic, and procedural security safeguards in the handling and maintenance of our patients’ medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction, or misuse.
TREATMENT: We may disclose your medical information, without your prior approval, to another physician or other health care provider(s) for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. This includes coordination or management of your health care with a third party. For example, your information may be disclosed to a surgeon to determine whether surgical intervention is needed.
PAYMENT: Your medical information may be used to seek payment from your insurance plan. For example, your insurance plan may request and receive information on dates that you received services at our facility to allow them to verify and process your insurance claim.
HEALTHCARE OPERATIONS: We may use or disclose your medical information without your prior approval for healthcare operations. Healthcare operations include:
We may disclose your information to another medical provider or health plan subject to federal privacy protection laws if the provider or plan has or had a relationship with you and the medical information is for that provider’s or plan’s health care quality assessment and improvement.
YOUR AUTHORIZATION: You or your legal representative may give us written authorization to use or disclose your medical information to anyone for any purpose. Once authorization is given, we cannot guarantee the information will not be redisclosed.
You may revoke your written authorization at any time in writing, except where we have already relied upon the authorization. Unless authorized, we will not use or disclose medical information beyond what is described in this notice.
We will obtain your authorization prior to using your medical information for marketing, fundraising, or commercial use. Once authorized, you may opt out of these communications.
FAMILY, FRIENDS, AND OTHERS INVOLVED IN YOUR CARE OR PAYMENT FOR CARE: We may disclose relevant medical information to individuals involved in your care or payment.
We may disclose your name, location, and general condition to assist an appropriate agency in locating or notifying someone responsible for your care during emergencies or disaster relief situations.
You will be given an opportunity to object unless you are incapacitated or an emergency exists. In such cases, professional judgment will be used.
REMINDERS: We may use or disclose medical information to send reminders about your care.
BUSINESS ASSOCIATES: We may disclose your medical information to business associates who perform services on our behalf and are contractually obligated to protect your information.
DATA BREACH NOTIFICATION PURPOSES: We may use your contact information to provide legally required breach notifications.
We may use or disclose your medical information without your permission when required or authorized by law, including:
If another law provides greater privacy protection, we will follow the more stringent law.
Certain federal and state laws require special protections for highly confidential information, including:
ACCESS: You have the right to examine and receive a copy of your medical information with limited exceptions. Requests must be submitted in writing. Records will be provided within 30 days.
Reasonable cost-based fees may apply. Certain records may not be requested under federal law, including psychotherapy notes and records prepared for legal proceedings.
DISCLOSURE ACCOUNTING: You may request a list of disclosures for up to six years prior.
AMENDMENT: You may request amendments to your medical information in writing.
RESTRICTION: You may request restrictions on use or disclosure. We are not required to agree in all cases.
BREACH NOTIFICATION: You have the right to receive notice of a breach of unsecured medical information.
CONFIDENTIAL COMMUNICATION: You may request confidential communication methods or locations.
ELECTRONIC NOTICE: If you received this notice electronically, you may request a paper copy.
IF YOU ARE CONCERNED THAT WE MAY HAVE VIOLATED YOUR PRIVACY RIGHTS, OR YOU DISAGREE WITH A DECISION WE MADE ABOUT ACCESS TO YOUR MEDICAL INFORMATION, ABOUT AMEDNING YOUR MEDICAL INFORMATION, ABOUT RESTRICTING OUR USE OR DISCLOSURE OF YOUR MEDICAL INFORMATION, OR ABOUT HOW WE COMMUNICATE WITH YOU ABOUT YOUR MEDICAL INFORMATION (INCLUDING A BREACH NOTICE COMMUNICATION), YOU MAY CONTACT OUR PRACTICE ADMINISTRATOR.