Our Legal Duty
We are
required by applicable federal and state law to maintain the
privacy of your health information. We are also required to give
you this Notice about our privacy practices, our legal duties,
and your rights concerning your health information. We must
follow the privacy practices that are described in this Notice
while it is in effect. This Notice takes effect on April 15,
2003 and will remain in effect until we replace it.
We reserve
the right to change our privacy practices and the terms of this
Notice at any time, provided such changes are permitted by
applicable law. We reserve the right to make the changes in our
privacy practices and the new terms of our Notice effective for
all health information that we maintain, including health
information we created or received before we made the changes.
Before we make a significant change in our privacy practices, we
will change this Notice and make the new Notice available upon
request.
You may
request a copy of our Notice at any time. For more information
about our privacy practices, or for additional copies of this
Notice, please contact us using the information listed at the
end of this Notice.
We use and disclose health information about you for treatment, payment, and healthcare operations. For examples: Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
Payment: We may use and disclose your
health information to obtain payment for services we provide
you.
Healthcare Operations: We may use and
disclose your health information in connection with our
healthcare operations. Healthcare operations include quality
assessment and improvement activities, reviewing the
competence or qualifications of healthcare professionals,
evaluating practitioner and provider performance, conducting
training programs, accreditation, certification, licensing,
or credentialing activities.
Your Authorization: In addition to our use
of your health information for treatment, payment or
healthcare operations, you may give us written authorization
to use your health information or to disclose it to anyone
for any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not
affect any use or disclosures permitted by your
authorization white it was in effect. Unless you give us a
written authorization, we cannot use or disclose your health
information for any reason except those described in this
Notice.
To
Your Family and Friends: We must disclose
your health information to you, as described in the Patients
Rights section of this Notice. We may disclose your health
information to a family member, friend, or other person to
the extents necessary to help with your healthcare or with
payment for your healthcare, but only if you agree that we
may do so.
Persons Involved In Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are so present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable interferences of
your best
interest in allowing a person to pick up filled prescriptions,
medical supplies, x-rays, or other similar forms of health
information.
Marketing Health-Related Services: We will not
use your health information for marketing communications without
your written authorization.
Required by Law: We may use your health
information when we are required to do so by law.
Abuse
or Neglect: We may disclose your health
information to appropriate authorities if we reasonably believe
that you are a possible victim of abuse, neglect, or domestic
violence or the possible victim of other crimes. We may disclose
your health information to the extent necessary to avert a
serious threat to your health or safety or the health or safety
of others.
National Security: We may disclose to military
authorities the health information of Armed Forces personnel
under certain circumstances. We may disclose to authorize
federal officials health information required for lawful
intelligence, counterintelligence, and other national security
activities. We may disclose to correctional institution or law
enforcement official having lawful custody of protected health
information of inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose
your health information to provide you with appointment
reminders (such as voicemail messages, postcards, or letters).
Access:
You have the right to look at or receive copies
of your health information, with limited exceptions. You may
request that we provide copies in a format other than
photocopies. We will use the format you request unless we cannot
practicably do so. (You must make a request in writing to obtain
access to your health information. You may obtain a form to
request access by using the contact information listed at the
end of this Notice. We will charge you a reasonable cost-based
fee for expenses such as copies and staff time. You may also
request access by sending us a letter to the address at the end
of this Notice. If you request copies, we will charge you $0.47
for each page, $20.00 per hour for staff time to locate and copy
your health information, and postage if you want the copies
mailed to you. If you request an alternative format, we will
charge you a cost-based fee for providing your health
information in that format. If you prefer, we will prepare a
summary or an explanation of your health information for a fee.
Contact us using the information listed at the end of this
Notice for a full explanation of our fee structure.)
Disclosure Accounting: You have the right to
receive a list of instances in which we or our business
associates disclosed your health information for purposes, other
than treatment, payment, healthcare operations and certain other
activities, for the last 6 years, but not before April 14, 2003.
If you request this accounting more than once in a 12-month
period, we may charge you a reasonable, cost-based fee for
responding to these additional requests.
Restriction: You have the right to request that
we place additional restrictions on our use or disclosure of
your health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by our
agreement (except in an emergency).
Alternative Communications: You have the right
to request that we communicate with you about your health
information by alternative means or to alternative locations.
(You must make your request in writing.) Your request must
specify the alternative means or location, and provide
satisfactory explanation how payments will be handled under the
alternative means or location you request.
Amendment: You have the right to request that
we amend your health information. (Your request must be in
writing, and it must explain why the information should be
amended.) We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice
on our website or by electronic mail (email), you are entitled
to receive this Notice in written form.
If you
want more information about our privacy practices, please
contact us.
If you are
concerned that we may have violated your privacy rights, or you
disagree with a decision we made about access to your health
information or in response to a request you made to amend or
restrict the use or disclosures of your health information or to
have us communicate with you by alternative means or at
alternative locations, you may complain to us using the contact
information listed at the end of this Notice. You may also
submit a written complain to the US Department of Health and
Human Services. We will provide you with the address to file
your complaint upon request.
We support
your right to the privacy of your health information. We will
not retaliate in any way if you choose to file a complaint with
us or with the US Department of Health and Human Services.
Contact
Officer: Christy Burke
Telephone:
573-364-1821