INTERNAL MEDICINE, PEDIATRICS, FAMILY PRACTICE & PHYSICAL THERAPY

NOTICE OF PRIVACY POLICY

This Notice describes how Medical Information about you may be used and disclosed and how you can get access to this information.  PLEASE REVIEW IT CAREFULLY.

Your medical information is personal and we are committed to protecting this information.  This notice applies to all of the records of your care generated by this office.  We are committed to protecting your medical information and your privacy.  We respect the right to keep your personal and healthcare information confidential.

We maintain physical, electronic, and procedural safeguards to protect patient information.

We permit only authorized personnel who are trained in the proper handling of Patient Information to have access to that information.  Employees who violate our Privacy Policy will be subject to disciplinary procedures.

If you decide to transfer your medical records and care to another medical provider, we are committed to adhere to the privacy policies and practices described in this notice.

How this office may use and disclose your medical information:

For Treatment:  We will use medical information about you to provide you with medical treatment and services.  We may disclose medical information about you to doctors, nurses, technicians and other office personnel who are involved in providing medical treatment.

For Payment:  We may use and disclose information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or a third party.

As Required by Law:  We will disclose medical information about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety:  We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would be to someone able to help prevent the threat.

Appointment Reminders:  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at this office.

Information Collecting:  We may receive information about you from referring physicians, insurance companies, pharmacies, attorneys, hospitals, employers, and federal, state, or local agencies.  We will collect and disclose this information only in accordance with applicable laws or regulations or in response to your request for release of protected health or personal information.

Information Sharing:  We may share information with third parties under the following conditions:

• Emergency medical care

• Referral to selected provider and/or hospital for medical care

• Pharmacies for initial prescriptions and refill prescriptions

• Applicable required reporting by law

Patient Rights

As a patient of this practice you have the right to:

• Receive medically necessary care.

• Considerate and courteous care with respect for your privacy and dignity.

• Receive information about your care in a manner that is understandable.

• Review your medical records by scheduling an appointment during regular business hours.

• Receive a copy of your medical information when requested in writing for a fee as designated by law.

• Submit a written amendment to your medical record.

• A candid discussion of appropriate medically necessary treatment options for your condition, regardless of cost or benefit coverage.

• Confidentiality regarding your health care.

• Refuse treatment to the extent permitted by law and be informed of the consequences of your actions.

• Request restrictions or limitations on the use or disclosure we make of your medical information.

As a patient of this practice you have the responsibility to:

• Read the Patient Privacy Policy, Financial Policy and all other patient materials, and call this office with any questions.

• Coordinate all non-emergency care through your referring physician and health care team.

• Follow the plans and instructions for care that you have agreed upon with your practitioners.

• Provide, to the extent possible, information that your practitioners need in order to provide medical care.

• Make and keep appointments for your medical care.  Call this office if you need to cancel your appointment.  (24-hour notice is required)

• Participate in the medical decisions regarding your health.

• Be considerate and courteous to providers, staff and other patients.

• Notify this office of address changes and additions or deletions of medications prescribed by other providers.

• Report all insurance programs that cover your health and/or your family's needs.

• Sign the appropriate consent form, when necessary, to provide protected health care information to third parties.

• Revoke consent to release individually identifiable medical information except to the extent of action that has already been taken.  Such revocation must be in writing.

• Restrict how protected health information is used or disclosed to carry out treatment, payment, or health care operations.