|
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY The Health Insurance
Portability & Accountability Act of 1996 (“HIPAA”) is a federal program
that requires all medical records and other individually identifiable health
information used or disclosed by us in any form, whether electronically, on
paper, or orally, be kept properly confidential. Confidentiality of your personal medical
information has always been of the utmost importance to us. However, we want to make you aware of the HIPAA
Act which went into effect April 14, 2003.
This federal law 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: treatment, payment and health care
operations. Ÿ
Treatment means providing, coordinating, and or managing health
care and related services by one or more health providers. An example would be to give you an eye exam
for a problem and
share those results with your primary care doctor. Ÿ
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. Ÿ
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 will 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
either by phone, voice mail, postcard or by written
letter. 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 that. 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 of this practice. Ÿ
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 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. Ÿ
The right to
reasonable requests to receive confidential communications of protected health
information from us by alternative means or at alternative locations. Ÿ
The right to
inspect and copy your protected health information. Ÿ
the right to request an amendment to correct your
personal health information that is incorrect or incomplete. Ÿ
The right to
receive an accounting of disclosures of protected health information not
relating to treatment, payment or healthcare operations. Ÿ
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. This notice is effective as
of April 14, 2003 and we are required to abide by the terms of the Notice of
Privacy Practices and to make the new notice provisions effective for all
protected health information that we maintain.
You have recourse if you feel
that your privacy protections have been violated. You have the right to file a 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 the policies and procedures of our office. We will not retaliate against you for filing
a complaint. Please contact our office for
your information. For more information about
HIPAA or to file a complaint: The US Department of Health
& Human Services Office of Civil Rights 200 Independence Ave, S.W. Washington, DC 20201 (202) 619-0257 Toll Free: 1-877-696-6775 |