This notice describes the various ways we use and disclose your personal health information. It further describes your rights and obligations with respect to the use or disclosure of your medical information.
We will also ask that you acknowledge receipt of this notice the first time you come to our facility because the law requires us to make a good faith effort to obtain your acknowledgement.
We are required by law to make sure that any medical or health information that we have that identifies you is kept private and will be used or disclosed in accordance with our Privacy Practices, provide you with the complete notice of our legal duties and our privacy practices and abide by the terms of these privacy practices.
Our Commitment to You
We are strongly committed to protecting your medical information. We create a medical record about your care in order to provide you with treatment and to comply with various legal requirements.
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed for the purpose of treatment, to obtain payment for services provided which includes any prior approval to determine whether your insurance will cover the device and for healthcare operations to support the business activities of this facility.
We may use or disclose your protected health information as necessary to remind you of your appointment and call you by name in the waiting room when we are ready to see you.
Uses and Disclosures of Protected Health Information Based Upon Your Written Approval
Other uses and disclosures of your protected health information will be made only with your written authorization. You may revoke your authorization, at any time, in writing. You understand that we cannot take back any use or disclosure we may have made under the authorization before we received your written revocation, and that we are required to maintain a record of the medical care that has been provided to you. We will not condition your treatment in any way on whether or not you sign any authorization.
Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, orally or in writing, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
Other Permitted and Required Uses and Disclosures Without Your Authorization
We may use or disclose your protected health information to the extent that the use or disclosure is required by federal, state or local law and for the purpose of controlling disease injury or disability only to prevent the threat to public health.
We may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally-established programs that provide benefits for work-related illnesses and injuries.
If you are a member of the military (active or veteran), we may release protected health information about you for the purpose of determining your eligibility for benefits or as required by military command authorities.
Who Does This Notice Apply To?
Any health care professional who treats you at any of our locations.
Any office staff member at any of our locations.
Any business associate with whom we share your health information with an order to provide services for you.
Your Rights Regarding Health Information
You have the right to inspect and obtain a copy of your protected health information contained in your medical records. To inspect or obtain a copy, you must submit a written request to the Privacy Contact. We may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request.
You have the right to request a restriction of your protected health information asking us not to disclose to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom the restriction applies.