Privacy Notice
THIS NOTICE IS EFFECTIVE 12/12/11 UNTIL FURTHER NOTICE.
Right to Notice As a patient, you have the right to
adequate notice of the uses and disclosures of your protected health
information. Under the Health Insurance Portability and Accessibility
Act (HIPAA), [Practice Name here] can use your protected health information
for treatment, payment and health care operations. a) Treatment - We
may use or disclose your health information to a physician or other
healthcare provider providing treatment to you. b) Payment - We may
use and disclose your health information to obtain payment for services
we provide you. c) Health care operations - We may use and disclose
your health information in connection with our healthcare operations.
Healthcare operations include quality assessment and improvement activities,
reviewing the competency or qualifications of healthcare professionals,
evaluating provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization Most uses and disclosures that do
not fall under treatment, payment, health care operations will require
your written authorization. Upon signing, you may revoke your authorization
(in writing) through our practice at any time.
Emergency Situations In the event of your incapacity
or an emergency situation, we will disclose health information to a
family member, or another person responsible for your care, using our
professional judgment. We will only disclose health information that
is directly relevant to the person's involvement in your healthcare.
Marketing We will not use your health information for
marketing communications without your written authorization.
Required by Law We may also use or disclose your health
information when we are required to do so by law.
Abuse or Neglect We may disclose your health information
to appropriate authorities if we reasonably believe that you are a possible
victim of abuse, neglect, or domestic violence or the victim of other
crimes. We may disclose your health information to the extent necessary
to avert a serious threat to your or other people's health or safety.
National Security We may disclose the health information
of Armed Forces personnel to military authorities under certain circumstances.
We may disclose health information to authorized federal officials required
for lawful intelligence, counterintelligence and other national security
activities. We may disclose health information of inmates or patients
to the appropriate authorities under certain circumstances.
Appointment Reminders We may use or disclose your health
information to provide you with appointment reminders via phone, e-mail
or letter.
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