How Practice/Clinic Name USES AND PROTECTS YOUR HEALTH INFORMATION
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule sets the standards of how we use and disclose your personal health information. We follow the HIPAA guidelines to keep your private health information protected and secure. Additionally, you have specific rights and choices about how your personal information is used and disclosed. This page details how we use your personal information and your rights with respect to that information.
How We May Use or Share Your Health Information
We maintain a record of the care and services you receive at our facility. This record is kept private and confidential. We typically use or share your health information to:
- Treat you. We can use your health information to treat you and any related conditions, as well as share it with other health professionals who are treating you when requested and with your approval.
- For healthcare operations. We can use and share health information to manage your treatment and services, improve your care, and contact you when necessary. We can also use your information to evaluate our services and the quality of care we provide to run and improve our practice.
- Bill for your services. We can use and share your health information to bill and get payment from health or vision plans that you ask us to direct bill.
Your Rights to Your Health Information
You have the following rights regarding the health information we maintain about you. These rights and responsibilities include:
- Request an electronic or paper copy of your medical record. You can ask to see or receive a copy of your medical record and other health information we have on file for you. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable fee to cover the cost of copying, mailing, or other supplies associated with your request. Contact our team if you’d like to request this information.
- Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. Contact our team to learn how to do this. It is possible that we may decline your request, but we’ll let you know why in writing within 60 days of your request.
- Request confidential communications. You can ask us to contact you in a specific way (e.g., home, office, or cell phone) or to send mail to a different address. We will follow all reasonable requests.
- Ask us to limit what we use or share. You can ask us not to share certain health information for treatment, payment, or our operations. We are not required to agree to this request, and may say “no” if it could affect your care. If we agree to your request, we may still share this information in the event of an emergency.
- Ask us not to share information with your health insurer. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
- Get a list of those with whom we’ve shared information. You can ask for a list of the times we’ve shared your health information for 6 years prior to the date you make the request, along with who we shared it with and why.
- Choose someone to act for you. If someone has the authority to act as your personal representative, such as your medical power of attorney or your legal guardian, that person can exercise your rights and make choices about your health information. We will verify this authority before we take any action.
- Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Your Choices About Your Health Information
For certain health information, you have options about what we share. If you have a clear preference for how we share your health information, let us know. Tell us what you want to do, and we will follow your instructions. You can direct us to share your information with your family, close friends, or others involved in your care or payment for your care.
In other cases, we will never share your information without express written permission from you. This includes information for marketing purposes or selling your information.
In the case of fundraising, we may contact you about our fundraising activities. If you prefer not to receive these communications, let us know, and we will opt you out.
Additional Situations Which Require the Use or Disclosure of Your Health Information
There are additional situations in which we are allowed or required to share your information. We have to meet specific conditions in the law before we can share your information for these purposes. These instances include:
- When required by law. We will share information about you if the state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
- Help with public health and safety issues. We can share health information in certain situations, such as to prevent disease, to help with product recalls, to report adverse reactions to medications, to report suspected abuse, neglect, or domestic violence, and to prevent or reduce a serious threat to anyone’s health or safety.
- Health research. We can use or share your information for health research.
- Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
- Work with a medical examiner or coroner. We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Workers’ compensation. We can use or share health information about you in relation to a workers’ compensation claim.
- Respond to lawsuits or legal action. We may disclose your health information in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process.
Our Responsibilities Regarding Your Health Information
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it, either electronically or physically.
We will not use or share your information other than as described in this notice unless you tell us that we can in writing. If you give us permission to share your information, you have the right to change your mind at any time. Let us know in writing if you change your mind.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request in our office and on our website.
Complaints
If you would like more information about your privacy rights, are concerned we have violated your privacy rights, or disagree with a decision we made about your personal health information, you can contact our team. You also have the right to file a complaint.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
We will not retaliate against you for filing a complaint.