Patient Privacy Notice
Effective April 14, 2003
In Accordance with the Federal Privacy Law (HIPAA):
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:
In accordance with the Federal Privacy Law (HIPAA), we keep medical information and records confidential and will only use them for patient treatment, health care operations and billing purposes.
TREATMENT: Our physicians, clinicians and staff will use your medical information to give you the best possible care.
HEALTH CARE OPERATION: We will use this information for appropriate follow-up care, patient notification, statistical and regulatory requirements and internal quality assurance programs.
BILLING PURPOSES: We will use your medical information to bill the appropriate third party(ies) for your care.
DISCLOSURE OF INFORMATION WITH EXTENUATING CIRCUMSTANCES
Health information will be given to family members in case of an emergency or under other circumstances with proper authorization and documentation.
Health information may be given to other physicians or institutions under emergency situations.
Information may be given to proper authorities when neglect or abuse is alleged or suspected.
Information may be provided to courts or other agencies when a subpoena is given to this office.
PATIENT RIGHTS
Effective April 14, 2003
In accordance with the Federal Privacy Law (HIPAA)
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:
Right to Access Records
Patients have the right to see and get copies of their records within thirty (30) days of request. The patient has a right to see anything in the record. Copies may be made and will be charged at the going rate of $6.00 per 5 pages plus any postage costs for mailing records.
Right to Request Restrictions
Patients have the right to request restrictions on who sees their records. Any request that is unreasonable will be dealt with on an individual basis.
Right to Confidential Communication
Patients have the right to receive communications about their record in a confidential manner. In this office, patients will be given a form to fill-out stating how they would like to be contacted.
Right to Amend the Record
Patients have the right to amend their records when they disagree with the content but physicians have the right to deny these requests. A record cannot be changed but a line may be drawn through the disputed entry. The physician may then write an addendum.
Right to an Accounting of Disclosures
Patients have the right to know everyone to whom the office discloses record information for purposes other than treatment, payment and health care operation.
A log, as required by HIPAA, will be kept showing each disclosure and the person to whom it is made. This will also show what information is provided and the purpose. This office will only log in the releases for which the patientÕs authorization is required.
Any questions about this policy can be directed to our Privacy Officer.
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Last page update: 9/07 |
