Patient Rights & Responsibilities

HIPAA-The Health Insurance Portability and Accountability Act of 1996

NOTICE OF PRIVACY PRACTICES OF THIS OFFICE  THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMTIAON.  PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 (“HIPPA”) is a federal program that requires that all medical records and other individual identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential.  This Act gives you, the patient, significant new rights to understand and control how your health information is used.  “HIPPA” provides penalties for covered entities that misuse personal health information.  

 

As required by “HIPPA”, 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.

 

We may use and disclose you medical records only for each of the following purposes:  treatment, payment and health care operations.

 

  • Treatment means providing, coordinating, or managing health care and related services by one or more health care providers.  An example of this would include a physical examination. 

 

  • Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review.  An example of this would be sending a bill for your visit to your insurance company for payment.

 

 • Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service.  An example would be an internal quality assessment review. 

 

We may also create and distribute de-identified health information by removing all references to individually identifiable information. 

 

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

 

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.

The Patient Has the Right To

Patient Responsibilities

Notice Of Patient Privacy

 

To mail a complaint, please type or print, and return completed complaint to:

Office for Civil Rights Department of Health and Human Services 

Attn: Patient Safety Act 

200 Independence Ave., SW, Rm. 509F Washington, DC 20201 

(202) 619-0403 

TDD 1-800-537-7697 

FAX: (202) 619-3818

 

To submit an electronic complaint, see our web site at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf