This notice describes how medical information about you may be used and disclosed and how you may access this information. Please review it carefully.
The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination, and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Examples of Uses of Your Health Information for Treatment Purposes are:
* A nurse obtains treatment information about you and records it in a health record.
* The specialist will share information with the referring physician.
Examples of Use of Your Health Information for Payment Purposes:
We submit requests for payment to your health insurance company. The health insurance company (or other business associaite helping us obtain payment) requests information from us regarding medical care given. We will provide information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evauluation, protocol and clinical guidline development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associaites as necessary to obtain these services.
Your Health Information Rights:
The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have a right to:
*Request a restriction on certain uses and disclosures of your health information by delivering the request to our office--we are not required to grant the request, but will comply with any request granted.
*Obtain a paper copy of the current Notice of Privacy Practices for Protected Health Information ('Notice') by making a request at our office;
*Request that you be allowed to inspect and copy your health record and billing record - may exercise this right by delivering the request to our office.
*Appeal a denial of access to your protected health information, except in certain circumstances;
*Request that your health care record be amended to correct incomplete or incorrect information by delivering a request to our office. We mmay deny your request if you ask us to amend information that:
*Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
*Is not part of the health information kept by or for the office;
*Is not part of the information that you would be permitted to inspect and copy;or,
*Is accurate and complete.
If your request is denied, you will be informed of the reason for th edenial and will have an opportunity to submit a statement of disagreement to be maintained with your records;
*Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office;
*Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a request to our office. An accounting will not include uses and disclosures of information for treatment, payment, or operations; dislcosures or uses made to you or made at your request; uses or disclosures made pursuant to an authorization signed by you; uses or disclosures made in a facility directory or to family members or friends relevant to that person's involvement in your care or in payment for such care; or, uses or disclosures to notify family or others responsible for your care of your location, condidtion, or your death.
*Revoke authorizations that you made previosly to use or disclose information by delivering a written revocation to our office, except to the extent information or action has already been taken.
If you want to exercise any of the above rights, please contact the practice manager at (303) 526-1117, in person or in writing, during regular, business hours. (S)he will inform you of the steps that need to be taken to exercise your rights.
Our Responsibilities
The office is required to:
*Maintain the privacy of your health information as required by lax;
*Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
*Abide by the terms of the Notice;
*Notify you if we cannot accommodate a requested restriction or request; and,
*Accomodate your reasonable requests regarding methods to communicate health information with you.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and acces practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a copy of the Notice by calling and requesting a copy or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the practice manager at (303) 526-1117. Additionally, if you believe your privacy rights have been violated, you may file a written complaint by delivering it to our office, attn: Practice Manager. You may also file a complaint by mailing it to the Secretary of Health & Human Services whose street address is Offices for Civil Rights - US Dept. of Health & Human Services 200 Independence Ave. S.W. - Room 509F, HHH Building - Washington DC 20201
*We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health & Human Services (HHS) as a condition of receiving treatment from the office.
*We cannot, and will not, retaliate against you for filing a complaint with the Secretary Of Health & Human Services.
Other Disclosures and Uses
Communication with Family * Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify , health information revelant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.
Notification *Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or you death.
Disaster Relief *We may use an disclose your protected health information to assist in disaster relief efforts.
Food and Drug Administration (FDA) *We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Workers Compensation *If you are seeking compensation through Workers Comp, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Comp.
Public Health *As authorized by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability; to report reactions to medications or problems with products; to notify a person who may have been exposed to a disease or who is at risk for contracting or spreading a disease or condition.
Abuse and Neglect *We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
Employers *We may release health information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you execute a specific authorization for the release of that information to your employer.
Correctional Institutions *If you are in inmate of a correctional institution, we may disclose to the institution or its agents the protected health information necessary for your health and the health and saftey of other individuals.
Law Enforcement *We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecution, or to the extent an individual is in the custody of law enforcement.
Health Oversight *Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings *We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your authorizion, or as directed by a proper court order.
Serious Threat *To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.
For Secialized Governmental Functions *We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
Coroners, Medical Examiners, and Funeral Directors *We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary for them to carry out their duties.
