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.
We may use and disclose your information for the following purposes: treatment, payment and health care operations.
Treatment means providing or directing your health services provided by one or more health providers. Examples of this would include: sharing you medical information with the hospital or other physicians.
Payment includes seeking reimbursement for services, verifying your coverage, billing and collecting payment for our services. Examples of this would include: billing your insurance plan; billing you for deductibles and co-payments; determining eligibility for insurance coverage; and follow-up on unpaid services.
Health care operations include the business of running our practice, such as quality assessment and improvement activities and participating in the quality programs of your payment plan. We may also be required to disclose your health information by federal, state or local laws. Examples of these disclosures could include: medical transcription services, workers' compensation or similar programs.
Other uses and disclosures of your health information will be made only with your written authorization. You may revoke that authorization in writing and we will honor your request, except for the actions we may have already taken relying on your original authorization.
You have the following rights to your protected health information. When you present a written request to our Privacy Officer, you may:
- Place restrictions on our disclosure of your health information to relatives, friends or any other person you identify. We may disagree with such a restriction, but if we do agree, your limitation or disclosure will be honored.
- Inspect and copy your protected health information.
- Request an amendment to your health information.
- Receive an accounting of the disclosures of your protected health information.
This notice is effective from the date indicated below. We reserve the right to change the terms of this Notice and will provide you with a copy of the new Notice of Privacy Practices upon request. A copy of the current Notice will be given to you each year when you complete the annual registration form.
If you feel your privacy protections have been violated, please contact our Privacy Officer, Kathy Anderson, at (269) 381-4577 or toll-free at 1-800-211-0666.
You may also file a written complaint to:
Department of Health & Human Services, Office of Civil Rights
200 Independence Avenue, SW
Washington, DC 20201
Or, call toll-free at 1-877-696-6775.
Our practice assures that you will not suffer retaliation for filing a complaint with our office or the Department of Health and Human Services.
Effective Date: 4-14-03