THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.
TO ACCESS TO THIS INFORMATION, - PLEASE REVIEW.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
Additionally, your confidential information may be used to remind you of an appointment electronically or provide you with information about treatment options or other health- related services. You may opt to release such information to friends, family members, and care givers. We will use and disclose your protected information when we are required to do so by federal, state, or local laws. We may disclose your protected health information to public health authorities that are authorized by law to collect such information. Your protected information may be disclosed in response to a court administrative order or a subpoena if you are involved in a lawsuit or similar proceedings. We will try to inform you of any court orders, giving you the opportunity to obtain and present us with a counter order to keep the information private.
We will release your protected health information if requested by law enforcement officials as permitted by law. We may release your protected health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information for funeral directors to perform their jobs. If you indicate that you are an organ donor, we may release protected health information to such organizations as you permit. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
We may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities. We may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We may disclose your protected health information to correctional institutions or law enforcement HIPAA officials if you are an inmate or under the custody of a law enforcement official. Purposes for such disclosure includes but is not limited to, the institution to needs to continue to provide health care services to you, for the safety and security of the institution, and/or to protect your health and safety or the health and safety of other individuals or the public.
We may release your protected health information for workers’ compensation and similar programs.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. You have certain rights regarding your protected health information, which you can exercise by presenting a written request:
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices. We are required by law to notify you promptly if a breach occurs that may compromise the privacy or security of your information.
We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
Please contact the privacy officer at 336-280-8301 or email@example.com
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201