This practice is required, by law, to
maintain the privacy and confidentiality of your protected health
information and to provide our patients with notice of our legal
duties and privacy practices with respect to your protected health
Disclosure of Your Health Care
We may disclose your health care information to other healthcare
professionals within our practice for the purpose of treatment,
payment or healthcare operations. (example)
- On occasion, it may be necessary
to seek consultation regarding your condition from other health
care providers associated with this practice.
- It is our policy to provide a
substitute health care provider, authorized by This practice to
provide assessment and/or treatment to our patients, without
advanced notice, in the event of your primary health care
provider's absence due to vacation, sickness, or other emergency situation.
We may disclose your health information to your insurance provider
for the purpose of payment or health care operations.
We may disclose your health information as necessary to comply with
State Workers' Compensation Laws.
We may disclose your health information to notify or assist in
notifying a family member, or another person responsible for your
care about your medical condition or in the event of an emergency or
of your death.
As required by law, we may disclose your health information to
public health authorities for purposes related to: preventing or
controlling disease, injury or disability, reporting child abuse or
neglect, reporting domestic violence, reporting to the Food and Drug
Administration problems with products and reactions to medications,
and reporting disease or infection exposure.
Judicial and Administrative
We may disclose your health information in the course of any
administrative or judicial proceeding.
We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a suspect,
fugitive, material witness or missing person, complying with a court
order or subpoena, and other law enforcement purposes.
We may disclose your health information to coroners or medical
We may disclose your health information to researchers conducting
research that has been approved by an Institutional Review Board.
It may be necessary to disclose your health information to
appropriate persons in order to prevent or lessen a serious and
imminent threat to the health or safety of a particular person or to
the general public.
We may disclose your health information for military, national
security, prisoner and government benefits purposes.
Change of Ownership
Your Health Information Rights
In the event that This practice is sold or merged with another
organization, your health information/record will become the
property of the new owner.
- You have the right to request
restrictions on certain uses and disclosures of your health
information. Please be advised, however, that this practice is
not required to agree to the restriction that you requested.
- You have the right to have your
health information received or communicated through an
alternative method or sent to an alternative location other than
the usual method of communication or delivery, upon your
- You have the right to inspect
and copy your health information.
- You have a right to request that
this practice amend your protected health information. Please be
advised, however, that this practice is not required to agree to
amend your protected health information. If your request to
amend your health information has been denied, you will be
provided with an explanation of our denial reason(s) and
information about how you can disagree with the denial.
- You have a right to receive an
accounting of disclosures of your protected health information
made by this practice.
- You have a right to a paper copy
of this Notice of Privacy Practices at any time upon request.
Changes to this Notice of
This practice reserves the right to amend this Notice of Privacy
Practices at any time in the future, and will make the new
provisions effective for all information that it maintains. Until
such amendment is made, This practice is required by law to comply
with this notice.
This practice is required by law to
maintain the privacy of your health information and to provide you
with notice of its legal duties and privacy practices with respect
to your health information. If you have questions about any part of
this notice or if you want more information about your privacy
rights, please contact: us by calling this office. If the Doctor is
not available, you may make an appointment for a personal conference
in person or by telephone within 2 working days.
Complaints about your Privacy rights or how This practice has
handled your health information should be directed to the doctor, by
calling this office. If the doctor is not available, you may make an
appointment for a personal conference in person or by telephone
within 2 working days.
If you are not satisfied with the
manner in which this office handles your complaint, you may submit a
formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201