Notice of privacy practices
This notice describes how medical information about you may he used and disclosed and how you can get access to this information. Please review it carefully. This notice takes effect immediately and remains in effect until we replace it.
1. Our pledge regarding medical information
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at our organization. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.
2. Our legal duty
The law requires us to:
Keep your medical information private:.
Give you this information describing our legal duties. Privacy practices and your rights regarding your medical information.
Follow the terms or the current notice.
We have the right to:
Change our privacy practices and the terms of’ this notice at any time, provided that the changes arc permitted by law.
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: before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
3. Use and disclosure of your medical information:
The following section describes different ways that we use and disclose medical information. Not every use or disclosure will be listed. However we have listed all of the different ways we are permitted to use and disclose medical information. 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 at our office address.
Funeral director, coroner, medical examiner
Specialized government functions
Court orders and judicial and administrative proceedings
Public health activities
Victims of abuse, neglect, or domestic violence
Workers compensation
Health oversight activities
For treatment
For health care operations
Additional uses and disclosures
Facility directory
Notification
Disaster relief
Research in limited circumstances
Law enforcement
Appointment reminders
4. Your individual rights
You have a right to:
Look at or get copies of certain parts of your medical information, you may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You must also request access by sending a letter to this clinic. If you request copies, we will charge you $20.00 Plus postage if you want the copies mailed to you. Contact us for a full explanation or our fee structure.
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).
Request that we communicate with you about your medical information by different means or at different locations, your request that we communicate your medical information to you by different means or at different locations must be made in writing to this clinic.
Request that we change certain parts of your medical information. We may deny your request if we did not create the information that you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
If you have received this notice electronically, and wish to receive a paper copy, you have the right to obtain a paper copy by making a request in writing to this clinic.
If you have any questions about this notice or if you think that we may have violated your privacy rights, please contact us. You may also submit a written complaint to the U.S. Department of health and human services. You may contact us to submit a complaint or submit requests involving any or your rights in section 4 of this notice by writing to this clinic. If you so desire, we will provide you with the address file your complaint with the U.S. Department of health and human services. We will not retaliate in any way if you choose to file a complaint.
We accept your direct communication through the portal! Please log in to send direct messages to our providers or office staff.