We respect your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.

Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations

For treatment:

• Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.
• We may also provide information to others providing you care. This will help them stay informed about your care.

For payment:

• We request payment from your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.

For health care operations:

• We use your medical records to assess quality and improve services.
• We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
• We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.
• We may contact you to raise funds.
• We may use and disclose your information to conduct or arrange for services, including:
  • Medical quality review by your health plan.
  • Accounting, legal, risk management, and insurance services.
  • Audit functions, including fraud and abuse detection and compliance programs.

Your Health Information Rights

The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you. You have a right to:

• Receive, read, and ask questions about this Notice.
• Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request. But we will comply with any request granted.
• Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information ("Notice").
• Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.
• Have us review a denial of access to your health information—except in certain circumstances.
• Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
• When you request, we will give you a list of disclosures of your health information. The list will not include disclosures to third-party payors or for any disclosures for treatment, payment or health care operations. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
• Ask that your health information be given to you by another means or at another location. Please sign, date, and give us your request in writing.
• Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.