The health and billing records we maintain are the physical property of this office. The information in it, however, you do have the filling rights which concern your protected health information. To exercise any of these rights, you must submit a written request to your provider.
You may request additional restrictions on the use or disclosure of your protected health information for treatment, payment or health care operations. We are not required to agree to a requested restriction. If we agree to a restriction, we will comply with the restriction unless an emergency or the law prevents us from complying with the restriction, or until the restriction is terminated.
We normally contact you by telephone or mail at your home address. You may request that we contact you by some other method or at some other location. We will not ask you to explain the reason for your request. We will accommodate reasonable requests. We may require that you explain how payment will be handled if an alternative means of communication is used.
You may inspect and obtain a copy of protected health information that is used to make decisions about your care or payment for your care. We may charge you a responsible cost based fee for providing the records. We may deny your request under limited circumstances, e.g., if you seek psychotherapy notes; information prepared for legal proceedings, or if disclosure may result in substantial harm to you or others.
You may request that your protected health information be amended. You must explain the reason for your request in writing. We may deny your request if we did not create the record unless the originator is no longer available; if you do not have a right to access the record, or if we determine that the record is accurate and complete. If we deny your request, you have the right to submit a statement disagreeing with our decision and have the statement attached to the record.
You may receive an accounting of certain disclosures we have made of your protected health information. We are not required to account for disclosures of treatment, payment, or health care operations; to family members or others involved in your health care or payment; for notification purposes; or pursuant to our facility directory or your written authorization. We will provide at your request one accounting within a twelve-month period free of charge. We may charge a reasonable cost-based fee for all subsequent requests during that twelve-month period.
You have the right to obtain a paper copy of this notice upon request.
We reserve the right to change the terms of our Notice of Privacy Practices at any time, and to make the new Notice provisions effective for all protected health information that we maintain. If we materially change our privacy practices, we will prepare a new Notice of Privacy Practices, which shall be effective for all protected health information that we maintain. You may obtain a copy of the current Notice from any staff member or by contacting your provider.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying your provider.
If you have any questions about this Notice, or if you want to object to or complain about any use or disclosure or exercise any right as explained above, please contact your provider.
We will obtain a written authorization from you before using or disclosing your protected health information and or any documentation related to psychiatric care and treatment or purposes other than those summarized above or otherwise required by law. You may revoke your authorization by submitting a written notice to your provider.
We may disclose protected health information, subject to specific limitations, for certain law enforcement purposes, including to identify, locate, or catch a suspect, fugitive, material witness or missing person; to provide information about the victim of a crime; to alert law enforcement that a person may have died as a result of a crime; or to report a crime.
We may disclose protected health information to authorized federal officials for national security activities.
We may disclose protected health information to a coroner or medical examiner to identify deceased persons, determine cause of death, or permit the coroner or medical examiner to fulfill their legal duties. We may also disclose information to a funeral director to allow them to carry out their duties.
We may use or disclose protected health information for research if approved by an institutional review board or privacy board and appropriate steps have been taking to protect the information.
We may disclose protected health information as authorized by workers’ compensation laws and other similar legally established programs.
We may disclose protected health information to our third party business associates who perform activities involving protected health information for us, e.g., billing or transcription services. Our contacts with the business associates require them to protect your health information.
If you are in the military, we may disclose protected health information as required by military command authorities.
If you are an inmate or in the custody of law enforcement, we may disclose protected health information if necessary for your health care; for the health and safety of others; or for the safety or security of the correctional institution.
We may use and disclose protected health information in the following instances without your written authorization unless you object. If you object, please notify your provider.
Unless you object, we may disclose protected health information to a member of your family, or to the person identified by you who is involved in your health care or the payment of your health care. We will limit the disclosure to the protected health information relevant to that person’s involvement in your health care or payment.
Unless you object, we may use or disclose protected health information to notify a family member or other person responsible for your care of your location and condition. Among other things, we may disclose protected health information to a disaster relief agency to help notify family members.