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NOTICE OF PRIVACY PRACTICES
As required by a federal law, the Health Insurance Portability
and Accountability Act (HIPAA), a Privacy Notice is being provided
to you. This notice describes how we may use and disclose your
protected health information. Protected health information is
information that is created or received by your health care provider,
and that relates to your past, present or future physical or mental
health or condition. THIS SUMMARY IS NOT A COMPLETE LISTING OF
HOW YOUR INFORMATION IS USED AND SHARED, but will explain briefly
what the notice says.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
WITHOUT YOUR CONSENT (authorization) or opportunity to object:
For treatment payment and operations
To contact you as part of our follow-up practices, to remind
you of a procedure date
When legally required, for law enforcement purposes
Risks to public health, serious threat to Health or Safety
WITHOUT YOUR CONSENT (authorization) but with the opportunity
We may disclose information to your family member or close friend.
ALL OTHER DISCLOSURES WILL BE DONE ONLY WITH YOUR WRITTEN PERMISSION
AS REQUIRED BY LAW.
YOU HAVE THE RIGHT TO:
Inspect and copy your protected health information (medical record)
Request amendments or corrections to your protected health information
Request a restriction on uses of your health information. We
are not required to comply with your request
Request confidential communications by alternative means or to
an alternative location
Request to know how your health information was shared other
than for treatment , payment or operations or those you agreed
to by signing an authorization.
Request and receive a copy of Privacy Practices
VIOLATION OF PRIVACY RIGHTS:
If you believe that your rights under the privacy standards have
been violated you have a right to file a complaint.