This office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination, test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Examples of Uses of Your Protected Health Information for Treatment Purposes are:
· During the course of treatment, the physician determines he/she will need to consult with another specialist in the area. He/she will share the information with such specialist and obtain his/her input.
· Our physician's support staff may obtain treatment information about you and records it in your health record.
Example of Use of Your Health Information for Payment Purposes:
We submit requests for payment to your health insurance company. The health insurance company (or other business associates assisting us to obtain payment) requests information from us regarding medical care given. We will provide information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
We obtain services from our insurers and other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guideline development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associates as necessary.
The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have a right to:
· Request a restriction on certain uses and disclosures of your health information by delivering the request to our office in writing - we are not required to grant the request, but we will comply with any request granted;
· Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information by making a request at our office, or by visiting our web site at www.racrehab.com.
· Appeals a denial of access to your protected health information, except in certain circumstances;
· Request that your health care record be amended to correct, incomplete or incorrect information by delivering a request, in writing, to our office, or by contacting the company's privacy officer. We may deny the request if you ask us to amend information that:
· Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
· Is not part of the health information kept by or for the office;
· Is not part of the information that you would be permitted to inspect and copy; or,
· Is accurate and complete.
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records;
Request that communication of your health information be made by alternative
means or at an
· Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting of disclosures will not include uses and disclosures of information for treatment, payment, or operation; disclosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to family members or friends relevant to that person's involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location, condition, or your death.
· Revoke authorizations that you made previously to use or disclose information by delivering a written revocation to our office, or privacy officer, except to the extent information or action has already been taken.
you want to exercise any of the above rights please contact the Privacy
Officer, at the information indicated below.
The office is required to:
· Maintain the privacy of your health information as required by law;
· Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
· Abide by the terms of this Notice;
· Notify you if we cannot accommodate a requested restriction or request; and,
· Accommodate your reasonable requests regarding methods to communicate health information with you.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our practices change we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our web site at www.racrehab.com.
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the Privacy Officer, at (877) 368-4330 extension 102 or at email@example.com.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to the office manager who will then contact the Privacy Officer.
You may also
file a complaint by mailing or telephoning the Secretary of Health and
Human Services, whose street address and email address is: Office for
Civil Rights - U.S. Department of Health and Human Services - 200 Independence
Avenue S.W. - Room 509F, HHH Building - Washington, D.C. 20201 ·
· We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.
· We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Other Disclosures and Uses
Drug Administration (FDA)
Medical Examiners, and Funeral Directors