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.
Disclosure of your health care information
- Treatment. We may disclose your health care information to other health care professionals within our practice for the purpose of treatment, payment, or health care operation. On occasion, it may be necessary to seek consultation regarding your condition from other health care providers associated with this practice. It is our policy to provide a substitute health care provider, authorized by this practice, to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.
- Payment. We may disclose your health information to your insurance provider for the purpose of payment of health care operations. As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to this practice for health care services rendered. If you pay your health care service personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement to you. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describes the health care services received.
- Worker’s Compensation. We may disclose your health information as necessary to comply with state Workers’ Compensation Laws.
- Emergencies. We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care, about your medical condition in the event of an emergency or your death.
- Public Health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing and controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medication, and reporting disease of infection exposure.
- Judicial and Administrative Proceedings. We may disclose your health information in the course of an administrative or judicial proceeding.
- Law Enforcement. We may disclose your health information to law enforcement officials for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.
- Deceased Persons. We may disclose your health information to coroners or medical examiners.
- Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.
- Public Safety. It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.
- Specialized Government Agencies. We may disclose your health information for military, national security, prisoner and government benefits purposes.
- Change of Ownership. In the event that this practice is sold or merged with another organization, your health information/record will become the property of the new owner.
- Appointment Reminders. Our practice may use and disclose your individual identifiable health information to contact you or your family and remind you of an appointment.
- Health Information Rights. You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that this practice is not required to agree to the restriction that you request. You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request. You have the right to inspect and copy your health information. You have a right to request that this practice amend your protected health information. Please be advised, however, that this practice is not required to agree to amend your protected health information. If your request to amend your health information is denied, you will be provided with an explanation of our denial reason and information about how you can disagree with the denial. You have the right to receive an accounting of disclosures of your protected health information made by this practice. You have the right to a paper copy of this Notice of Privacy Practices at any time upon request.
- Changes to this Notice of Privacy Practices. This practice reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provision effective for all information that it maintains. Until such amendment is made, this practice is required by law to comply with this Notice. This practice is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have any questions about any part of this notice or if you want more information about your privacy rights, please contact our office. If you are not satisfied with the manner in which this office handles your privacy, you should submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC 20201