NOTICE OF CONFIDENTIALITY PRACTICES
IMPORTANT: THIS NOTICE DEALS WITH THE SHARING OF INFORMATION
FROM YOUR MEDICAL RECORDS. PLEASE READ IT CAREFULLY
This notice describes your confidentiality rights as they
relate to information from your medical records and explains the circumstances
under which information from your medical records may be shared with others.
The information in this notice also applies to others covered under your
health plan, such as your spouse or children. If you do not understand
the terms for this notice, please ask for further explanation (Chapter
Under the new law, you have the right to:
- Inspect and request copies of your medical records or to appeal any
denial of your request for inspection or copying.
- Request that your health care provider append information to your
- Receive a notice of your privacy rights by your health plan upon enrollment,
annually and when their confidentiality practices are substantially
- Obtain a copy of this office's confidentiality practices.
USES OF INFORMATION
This office uses your protected health information to provide you with
health care services. Under the law, your health information may also
be used by such entities as health plans for the following purposes:
- Payment to physicians and hospitals who provide you with health care
services- > Conducting quality assurance activities or outcomes assessments.
- Reviewing the competence or qualification of health care professionals.
- Performing accreditation, licensing or credentialing activities.
- Analyzing health plan claims or health care records data.
- Evaluating provider clinical performance.
- Carrying out utilization management.
- Conducting or arranging auditing services in accordance with statute,
rule, or accreditation requirements.
Except for the purposes outlined above, your health information may
not be disclosed without your authorization.
LIMITING DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
You have the right to limit disclosure of your protected health information
if you choose to not use any health insurance or other third party payment
as payment for services. In which case, you may only limit disclosure
if you have advised the physician prior to the delivery of services and
have paid for the health care services yourself.