Privacy Notice

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.

Our Duties:

We are required by law to maintain the privacy of your PHI (Protected Health Information). We must abide by the terms of this notice or any update of this notice.

Your rights:

You have the following rights concerning your PHI:

• To request restricted access to all or part of your PHI. To do this, ask for, complete, and return to this office a privacy restriction form. We are not required to grant your request.
• To receive correspondence of confidential information by alternate means or locations. To do this, ask for, complete, and return to this office a privacy restriction form.
• To inspect or receive copies of your protected health information. To inspect your PHI, set up an appointment for the inspection. To receive a copy of your PHI, ask our office to copy and mail your records to you.
• To request changes be made to your PHI. To do this, complete a change of protected health information form and return it to this office. We are not required to grant your request.
• To receive an accounting of the disclosures by this office of your PHI in the six years prior to your request. To do this, notify this office in writing that you would like a list of all individuals and organizations to which your PHI has been sent.
• To get updates or reissue of this notice, at your request.
• To complain to this office or the U.S. Department of Health and Human Services if you feel your privacy rights have been violated. To register a complaint with this office, complete a protected health information complaint form and return it to this office. The law forbids this office from taking retaliatory action against you if you complain.

Uses and Disclosures:

We will use and disclose elements of your protected health information (PHI) in the following ways:

• Treatment - Payment - Health care operations
• When law, including in judicial settings and to health oversight regulatory agencies and law enforcement, requires release.
• In emergency situations or to avert serious health/safety situations.
• To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.
• To organ, tissue and other donations organizations, upon or proximate to your death, if we have no indication on hand about your donation preferences (or a positive indication).
• To contact you about appointment reminders, treatment alternatives and other health related benefits and services.
• All other uses and disclosures by this office will require this office to obtain from you a written authorization in addition to any other permission you will provide this office.