NOTICE OF PRIVACY PRACTICES
Effective Date November 17, 2003
THIS DOCUMENT DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED
AND DISCLOSED AND THE PROCESS NECESSARY TO ACCESS THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.
USES AND DISCLOSURES
Treatment: Staff, doctors, nurses, technicians, or other medical personnel may use your information to evaluate your health, diagnose medical conditions and provide treatment. For example, laboratory tests results could be used to help us reach a diagnosis.
Payment: Your health information may be used in order to bill and collect payment for the services and items you receive from our practice. For example, your health insurer may request information regarding your treatment to determine coverage.
Health Care Operations: Your health information may be used and disclosed to support the operation of our business. For example our practice may evaluate the quality of care you received from us to assist cost-management or business planning activities.
OTHER USES AND DISCLOSURES
Required By Law: Your health information may be disclosed to law enforcement agencies to support audits, investigations or government-mandated reporting as required by law.
Public Health: Your health information may be disclosed to public health authorities as required by law.
Release of Information to Family/Friends: Your health information may be disclosed to friends or family members who assist in taking care of you.
Health Oversight Activities: Your health information may be disclosed to a health oversight agency for activities authorized by law. Lawsuits and Similar
Proceedings: Your health information may be disclosed in response to a court or administrative order or similar proceedings but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
Research: Your health information may be disclosed for research purposes in certain limited circumstances to researchers when approved by an Institutional Review Board and when certain research protocols have been met.
Serious Threats to Health or Safety: Your health information may be disclosed when necessary to reduce or prevent a serious threat to you, another individual or the public. Under these circumstances, we will only make disclosures to help prevent the threat.
Military: Your health information may be disclosed if you are a member of U.S. or foreign military force (including veterans) and if required by the appropriate authorities.
Inmates: Your health information may be disclosed to correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement.
Workers' Compensation: Your health information may be disclosed for workers' compensation and similar programs.
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