PLEASE REVIEW CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program, which requires 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 the 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.
We may also create and distribute de-classified health information by removing all references to individually identifiable information.
We may also 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 disclosers 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 action relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by preparing a written request to the Privacy Officer:
We are required by law to maintain the privacy of your protected health information and to provide you notice of our legal duties and privacy practices with respect to protected health information.
The Notice is effective as of April 1, 2003 and 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 provision effective for all protected health information tat we maintain. This will be posted in our office and you may also request a written copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy has been violated. You have the right to file a formal written complaint with our office or with the Department of Health and Human Services Office of Civil Rights, about violations of the provisions of the notice or the practice and procedures of our office. We will not retaliate against you for filing a complaint.
This Notice is a brief description of our privacy practices. For the complete notice please request a copy from the receptionist.
Please contact us for more information by asking to speak to the Privacy Officer or for written inquires not “Attention Privacy Officer”.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Ave. SW
Washington, D.C. 20201
Toll Free 877-896-8775