NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
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 01-01-2003, 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 of 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.
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
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 the 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 of disclosure of your health information, we will provide you
with an opportunity to object to such uses or disclosures. In the event of you 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, 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 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. You may obtain a form to
request access by using the contact information listed at the end of the 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 $ for each page, $ 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 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 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
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 Web site 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. 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 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 at the end of the Notice.
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.