|
OUT LEGAL DUTY
The law requires us to:
1. Keep your medical information private.
2. Give you this notice describing our legal duties, privacy practices, and
your rights regarding your medical information.
3. Follow the terms of the notice that is now in effect.
We have the Right to:
1. Change our privacy practices and the terms of this notice at any time,
provided that the changes are permitted by law.
2. Make the changes in our privacy practices and the new terms of our notice
effective for all medical information that we keep, including information
previously created or received before the changes.
Notice of Change to Privacy Practices:
1. Before we make an important change in our privacy practices, we will
change this notice and make the new notice available upon request.
USE AND DISCLOSURE OF YOU MEDICAL INFORMATION
This is how we use and disclose medical information. Note: We will not use
or disclose your medical information for any purpose not listed below,
without your specific written authorization. Any specific written
authorization you provide may be revoked at any time by writing to us.
FOR TREATMENT:
We may use medical information about you with medical treatment or services.
We may disclose medical information about you to doctors, nurses,
technicians, medical students, or other people who are taking care of you.
We may also share medical information about you with your other health care
providers to assist them in treating you. Your pharmacist may also need
information in order to fill your prescriptions.
FOR PAYMENT:
We may use and disclose your medical information for payment purposes.
FOR HEALTH CARE OPERATIONS:
We may use and disclose your medical information for our health care
operations. This might include measuring and improving quality, evaluating
performance of employees, conducting training programs, and getting the
accreditation, certificates, licenses, and credentials we need to serve you.
ADDITIONAL USE AND DISCLOSURES:
In addition to using and disclosing your medical information for treatment,
payment, and health care operations, we may use and disclose medical
information for the following purposes.
Disclosure of medical information to an employer or school in connection
with return to work or school notes at your request.
Disclosure of health information made to a school in connection with
clearance for camp or for participation in sports and other activities at
your request.
Disclosure made to other types of sports or recreational camps or daycare
centers at your request.
Notification:
Medical information to notify or help notify: a family member, your personal
representative, another person responsible for your care.
We will share information about your location, general condition, or death.
If you are present, we will get your permission if possible before we share
information, or give you the opportunity to refuse permission. In case of
emergency, and if you are not able to give or refuse permission, we will
share only the health information that is directly necessary for your health
care, according to our professional judgment. We will also use our
professional judgment to make decisions in your best interest about allowing
someone to pick up medicine, medical supplies, x-ray, or medical information
to you.
Disaster Relief:
Medical information with a public organization or person who can legally
assist in disaster relief effort.
RESEARCH IN LIMITED CIRCUMSTANCES:
Medical information for research purposes in limited circumstances where the
research has been approved by a review board that has reviewed the research
proposal and established protocols to ensure the privacy of medical
information.
FUNERAL DIRECTOR, CORONER, MEDICAL EXAMINER:
We may share the medical information about a person who has died with a
coroner, medical examiner, funeral director, or an organ procurement
organization to help them carry out their duties.
SPECIALIZED GOVERNMENT FUNCTIONS:
Subject to certain requirements, we may disclose or use health information
for military personnel and veterans, for national security and intelligence
activities, for protective services for the President and others, for
medical suitability determinations for the Department of State, for
correctional institutions and other law enforcement custodial situations,
and for government programs providing public benefits.
PUBLIC HEALTH ACTIVITIES:
AS COURT ORDERS AND JUDICIAL AND ADMINISTRATIVE PROCEEDINGS:
We may disclose medical information in response to a court or administrative
order, subpoena, discovery request, or other lawful process, under certain
circumstances. Under limited circumstances, such as a court order, warrant,
or grand jury subpoena, we may share your medical information of a suspect,
fugitive, material witness, crime victim, or missing person. We may share
the medical information of an inmate or other person in lawful custody with
a law enforcement official or corequired by law, we may disclose your
medical information to public health or legal authorities charges with
preventing or controlling disease, injury, or disability, including child
abuse or neglect. We may also disclose your medical information to persons
subject to jurisdiction of the Food and Drug Administration for purposes of
reporting adverse events associated with product defects or problems, to
enable product recalls, repairs, or replacements, to track products, or to
conduct activities required by the Food and Drug Administration. We may
also, when we are authorized by law to do so, notify a person who may have
been exposed to a communicable disease or otherwise be at risk of
contracting or spreading a disease or condition.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE:
We may disclose medical 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 share your
medical information it it is necessary to prevent a serious threat to your
health or safety or the health or safety of others. We may share medical
information when necessary to help law enforcement officials capture a
person who has admitted to being part of a crime or has escaped from legal
custody.
WORKERS COMPENSATION:
We may disclose health information when authorized and necessary to comply
with laws relating to workers compensation or other similar programs.
HEALTH OVERSIGHT ACTIVITIES:
We may disclose medical information to an agency providing health oversight
for oversight activities authorized by law, including audits, civil,
administrative, or criminal investigations or proceedings, inspections,
licensure or disciplinary actions, or other authorized activities.
LAW ENFORCEMENT:
Under certain circumstances, we may disclose health information to law
enforcement officials. These circumstances include reporting required by
certain laws (such as the reporting of certain types of wounds), pursuant to
certain subpoenas or court orders, reporting limited information concerning
identification and location at the request of a law enforcement official,
reports regarding suspected victims of crimes at the request of a law
enforcement official, reporting death, crimes on our premises, and crimes in
emergencies.
YOUR INDIVIDUAL RIGHTS
You have a right to:
1. Look at or get copies of your medical information. You must make your
request in writing . You may ask the receptionist for the form needed to
request access. There may be charges for copying and for postage if you want
copies mailed to you.
2. Receive a list of all the times we or our business associates shared your
medical information for purposes other than treatment, payment, and health
care operations and other specified exceptions.
3. Request that we place additional restrictions on our use or disclosure of
your medical information. We are not required to agree to these additional
restrictions, but if we do, we will abide by our agreement (except in the
case of an emergency).
4. Request that we communicate with you about your medical information by
different means or to different locations. Your request must be made in
writing to our Privacy Officer. (It is the policy of this clinic that if we
need to contact you we will only call you at home or notify you by mail if
unable to reach you by phone).
5. Request that we change your medical information. We may deny your request
if we did not create the information you want changed or for certain other
reasons. If we deny your request, we will provide you with a written
explanation. You may respond with a statement of disagreement that will be
added to the information you wanted changed. If we accept you request to
change the information, we will make reasonable efforts to tell others,
including people you name, or the change and to include the changes in any
future sharing of that information.
QUESTIONS AND COMPLAINTS
If you have any questions about this notice, please ask to speak to our
Privacy Officer.
If you think that we may have violated your privacy rights, contact our
Privacy Officer. You may also submit a written complaint to the U.S.
Department of Health and Human Services.
THESE PRIVACY PRACTICES ARE CURRENTLY IN EFFECT AND WILL REMAIN IN EFFECT
UNTIL FURTHER NOTICE. |
