NOTICE OF PRIVACY PRACTICES

Effective Date: September 2, 2021

YOUR PRIVACY IS OF THE UTMOST IMPORTANCE TO US

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU MAY ACESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

This Notice explains the ways on which we may use and disclose your Protected Health Information. “Protected Health Information” is information about you It describes your rights and certain obligations have regarding the use and disclosure of your Protected Health Information. The law requires us to (1) Ensure your Protected Health Information is protected; (2) Provide you with this Notice describing our legal duties and privacy practices with respect to Protected Health Information; (3) Follow the current terms of the Notice in Effect

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your Protected Health Information may be used and disclosed in the following circumstances:

Treatment. We may use Protected Health Information about you to provide you with medical treatment or services. We may disclose Protected Health Information about you to doctors, nurse, technicians, or other personnel who are involved in your care. We may also share Protected Health Information about you with our office personnel or other providers, agencies or facilities in order to provide or coordinate such things as prescriptions, lab work and x-rays. We also may disclose Protected Health Information about you to people outside our office who may be involved in your continuing medical care after you leave our office such as other health care providers, transport companies, community agencies and family members.

Payment. We may use and disclose Protected Health Information about the treatment and services you receive so that payment may be collected from you, an insurance company, or a third party. We may also tell your health plan about a proposed treatment in order to obtain prior approval or to determine whether your plan will cover the treatment.

Healthcare Operations. We may use Protected Health Information about you to support our office operations. These uses and disclosures are made to improve our quality of care. Your Protected Health Information may be used or disclosed to Copley with laws and regulations, for contractual obligations, patients claims, grievances or lawsuits, health care contracting, legal services, business planning and development, business management and administration, the sale of all or part of our office to another entity, underwriting and other insurance activities. We may also disclose information to doctors, nurses, technicians and other personnel for performance improvement and educational purposes.

Appointment Reminders. We may contact you to remind you that you have an appointment at our office.

Treatment Alternatives. We may tell you about or recommend possible treatment options or alternative that may be of interest to you.

Health-Related Benefits and Services. We may tell contact you to tell you about benefits or services that we provide.

As Required by Law. We will disclose Protected Health Information about you when required to do so by international, federal, state or local law.

PATIENT’S RIGHTS

The following is a statement of your rights with respect to your Protected Health Information and a brief description of how you may exercise those rights:

• Other use and disclosure of your PHI will be made only with your written authorization unless permitted or required by law
• You may revoke this authorization in writing at any time as long as no action has already been taken.
• You have the right to inspect and copy your Personal Health Information for as long as we maintain the Personal Health Information. You may not inspect or copy psychotherapy notes, information compiled in anticipation of a civil or criminal proceeding, laboratory results that are subject to law that prohibit access if you singed you authorization rights due to a trial program. As permitted by federal law, we may charge you a reasonable copy fee for a copy of your records.
• You have the right to request a restriction of your Personal Health Information for the purpose of treatment, payment or personal healthcare operations when payment for the treatment has been made in full form out of pocket expense. You may also request Personal Health Information not be disclosed to family members or friends who may be involved in your care. You physician is not required to agree to a restriction that you may request.
• You have the right to request to receive confidential communications by alternative means or locations.
• You have the right to have your physician amend your Personal Health Information, in certain cases we may deny your request for amendment.
• Your Personal Health Information cannot be used for marketing products and services without authorization from you.
• You have the right to receive a n accounting of certain disclosures we have made, if any, on you Personal Health Information. This excludes disclosures we may have made for you if you authorized us to make the disclosure, for participating physicians who consult or assist with your care, for national security or other law enforcement disclosures.
• You have the right to complaint to use or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our administrative office. We will not retaliate against you for filing a complaint.
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If there are any questions regarding this privacy policy or you believe your rights have been violated or you wish to file a complaint about our privacy proactive, you may contact our office at (412) 123-4567