The privacy of your medical information is important to us.  We understand that your medical information is personal and we are committed to protecting it.  We create a record of the care and services you receive at our office.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice will tell you abut the ways we may use and share medical information about you.  We also describe your rights and certain duties we have regarding the use and disclosure of medical information (referred to as MI below).

Our Legal Duty:

Law requires us to:                                                           

§         Keep your MI private.                                            

§         Give you this notice describing our legal duties, privacy practices, and your rights regarding your MI.

§         Follow the terms of the current notice.

We have the right to:

§         Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.

§         Make the changes in our privacy practices and the new terms of our notice effective for all MI that we keep, including information previously created or received before changes.

Notice of change to privacy practices:

§         Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.

Use and Disclosure of Your Medical Information

The following section describes different ways that we may use and disclose MI.  Not every use or disclosure will be listed. We will not use or disclose your MI for any purpose not listed below without your specific written authorization.  Any specific written authorization you provide may be revoked at any time by writing to us.

For treatment:

We may use MI about you to provide you with medical treatment or services.  We may disclose MI about you to doctors, nurses, technicians, medical students or other people who are taking care of you. We may also share MI about you to your other health care providers to assist them in treating you.

For Payment:

We may and disclose your MI for payment purposes.  A bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include your MI.

For Health Care Operations:

We may use and disclose your MI for our health care operations. This might include measuring and improving quality, evaluating the performance of employees conducting training programs, and getting the accreditation certificates, licenses, and credentials we need to serve you.

Additional Uses and Disclosures:

In addition to using and disclosing your medical information for treatment, payment, and health care operations, we may use and disclose medical information for the following purposes.

Notification:

 We may use and disclose MI to notify or help notify:  a family member, your personal representative, or another person responsible for your care.  We will share information about your location, general condition, or death.  If you are present, we will get your permission if possible before we share, or give you the opportunity to refuse permission.  In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment.  We will also use our professional judgment in your best interest about allowing someone to pick up medicine, medical supplies, or medical information about you.

Disaster Relief:

We may share medical information with a public or private organization or person who can legally assist in disaster relief efforts.

Research in Limited Circumstances:

We may use medical information for research purposes in limited circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information.

Funeral Director, Coroner, Medical Examiner:

To help them carry out their duties, we may share the MI of a person who has died, with a coroner, medical examiner, funeral director, or an organ procurement organization.

Specialized Governament Functions:

Subject to certain requirements, we may disclose or use health information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits. 

Workers Compensation:

We may disclose health information when authorized or necessary to comply with laws relating to workers compensation or other similar programs.

Appointment Reminders:

We may use and disclose MI for purposes of sending you appointment postcards or otherwise reminding you of your appointments.

Your Individual Rights:

You have the right to:

§         Look at or get copies of certain parts of your MI.  You may request that we provide copies in a format other than photo copies.  We will use the format you request unless it is not practical for us to do so.  You must make your request in writing.  You may ask the receptionist for the form needed to request access. There may be charges for copying and or postage if you want the copies mailed to you.

§         Receive a list of all the times we or our business associates shared your MI for purposes other than treatment, payment, and health care operations and other specified exceptions.

§         Request that we place additional restrictions on our use or disclosure of your MI.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement. (except in the care of an emergency)

§         Request that we communicate with you about your MI by different means or to different locations. Your request that we communicate your MI to you by different means or at different locations must be made in writing to our Privacy Officer.

§         Request that we change certain parts of your MI. We may deny your request if we did not create the information you want changed or for certain other reasons.  If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed.  If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.

Questions and Complaints:

If you have any questions about this notice, please ask the receptionist to speak to our Privacy Officer. If you think that we may have violated your privacy rights, you may speak to our Privacy Officer and submit a written complaint. To take either action, please inform the receptionist that you wish to contact the Provacy officer or request a complaint form. You may submit a written complaint to the U.S. department of Health and Human Services; we will provide you with the address to file your complaint. We will not retaliate in any way if you choose to file a complaint.