This notice of Privacy Practices describes how we may use and disclose you protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required or permitted by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage you health and any related services. This includes the coordination of management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to provide a physician that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining pre-certification or authorization for the diagnostic procedure may require that your relevant protected health information be disclosed to the insurance company to obtain approval for a procedure.

Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. The activities include, but are not limited to, quality assessment activities, employee review activities, training of medical tech students, licensing, and conducting or arranging for other business activities with contracted business partners. For example, we may disclose your protected health information to medical school students (if applicable) that may see patients in our office, In addition, we may use a sign in sheet at the registration desk where you will be asked to sign your name and indicate your physician’s name. We may also call you by name in the waiting room when our technologist is ready to see, you. We may use or disclose your protected health information, as necessary, to contact you to remind you of any upcoming appointment. We may use or disclose your protected health information in the following situations without your authorization. These situations include: As require by law, Public Health issues required by law, Communicable Diseases: Health Oversight: Abuse or neglect: Food and Drug Research: Criminal Activity: Military Activity: and National Security: Workers Compensation: Inmates: Required Uses and Disclosure: Under the Law, we must make disclosures to you and where required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Other Permitted and Required Uses and Disclosures: Will be made only with your consent, authorization or opportunity to object unless required by law.

You may revoke this authorization, at any time, in writing, except to the extent that your physician’s practice
has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights
Following is a statement of you rights with respect to your protected information.

You have the right to inspect and copy your protected health information: Under federal law, However, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information: This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to any restriction that you may request. If the physician believes it is in your best interest to permit use and disclosure of you protected health information, your protected health information will not be restricted. You then have the right to use another Health Care Professional.

You have the right to request a restriction to receive confidential communications from us by alternate means or at an alternate location (if applicable). You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively.

You have the right to have your physician amend your protected health information.
If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us or any of our business partners. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before April 14th, 2008.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to the form please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.

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