NOTICE OF PRIVACY PRACTICES
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 April 14, 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. For
more information about our privacy practices, or to request a copy of
our Notice, please contact us using the information listed on this
website.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment,
payment, and healthcare operations. For example:
- 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 to 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 while 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 Patient Rights section of
this Notice. We may disclose your health information to a family
member, friend, or other person to the extent 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 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 inferences 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 or disclose 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, 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 authorized 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).
PATIENT RIGHTS
- Access: You have the right to look at or get 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. We
may charge you a reasonable cost-based fee for expenses such as
copies and staff time. If you request an alternative format, we will
charge a cost-based fee for providing your health information in
that format.
- 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, 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 Communication: 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 (e-mail), you are entitled to receive this
Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have
questions or concerns, please contact us at the address or phone
number provided on this website.
If you are concerned that we may have violated your privacy rights,
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 disclosure 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 on this
website. You also 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 with the U.S. Department of Health and
Human Services 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 U.S. Department of Health and Human Services.