Notice of Privacy Practices
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.
I am legally required to protect the privacy of your Protected Health Information (PHI), which includes information that can be used to identify you that I've created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. I must provide you with this Notice about my privacy practices, and such Notice must explain how, when, and why I will "use" and "disclose" your PHI. A "use" of PHI occurs when I share, examine, utilize, apply, or analyze such information within my practice; PHI is "disclosed" when it is released, transferred, has been given to, or is otherwise divulged to a third party outside my practice.
You can request a copy of this Notice from me, or you can view a copy of it in my office.
Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Prior Written Consent:
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For treatment: I can disclose your PHI to physicians, psychiatrists, psychologists, and other licensed health care providers who provide you with health care services or are involved in your care.
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To obtain payment for treatment: I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you. I may also provide your PHI to billing companies, claims processing companies, and others that process my health care claims.
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For health care operations: I can disclose your PHI to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided such services to you. I may also provide your PHI to accountants or attorneys to make sure I'm complying with applicable laws.
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Other disclosures: I may disclose your PHI if you need emergency treatment, as long as I try to get your consent after treatment is rendered.
Certain Uses and Disclosures Do Not Require Your Consent:
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When disclosure is required by federal, state, or local law; judicial or administrative proceedings; or, law enforcement: For example, I may make a disclosure to applicable officials when a law requires me to report information to government agencies and law enforcement personnel about victims of abuse or neglect, or when ordered in a judicial or administrative proceeding.
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For public health activities: For example, I may have to report information about you to the county coroner.
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For health oversight activities: For example, I may have to provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
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For research purposes: In certain circumstances, I may provide PHI in order to conduct medical research.
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To avoid harm: In order to avoid a serious threat of harm, I may disclose PHI to law enforcement personnel or persons able to prevent or lessen such harm.
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For specific government functions: I may disclose PHI of military personnel and veterans in certain situations and for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
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For workers' compensation: I may provide PHI in order to comply with workers' compensation laws.
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Appointment reminders and health related benefits or services: I may use PHI to provide appointment reminders or inform you of treatment alternatives, or other health care services or benefits I offer.
Certain Uses and Disclosures Require You to Have the Opportunity to Object:
I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
Other Uses and Disclosures Require Your Prior Written Authorization:
In any other situation not described about, I will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke it in writing to stop any future uses and disclosures of your PHI by me.
