The Practice may disclose your health information without your authorization when permitted or required by law, including:
- For public health activities, including reporting of certain communicable diseases
- To the Food and Drug Administration (FDA)
- For workers’ compensation or similar programs as required by law
- To authorities when abuse, neglect or domestic violence is suspected
- If you are an inmate of a correctional facility
- To health oversight agencies
- To your employer if we provide health care services to you at the request of the employer, whereupon we shall provide you written notice of release of such information
- For certain judicial and/or administrative proceedings pursuant to an administrative order
- For law enforcement purposes
- To a medical examiner, coroner or funeral director
- For the facilitation of organ, eye or tissue donation, if you are an organ donor
- For research purposes under strictly limited circumstances
- To avert a serious threat to your health and safety or that of others
- To follow various mandates for clinical quality metrics reporting, benchmarking and/or related matters
- For government purposes, such as military service or national security
- In the event of an emergency or for disaster relief
- In any other circumstances required by law
- On the sign-in sheet at the offices of the Practice
Unless you object, the Practice may also disclose your health information to family members and/or others involved in your care or payment for your care. The Practice may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person responsible for your care, general condition or death.
The Practice may leave messages for you at work or home about your visits. If you do not want the Practice to do so, please inform our Privacy Officer in writing. All other uses and/or disclosures of your health information to others will require a written, signed authorization from you. You have the right to revoke your authorization at any time, except to the extent the Practice has already acted on it. Should you require your records to be released, the Practice will provide you with an authorization form to complete and return to the address listed on it.
Your health record is the physical property of the Practice. The information contained in it belongs to you. Below is a list of your rights regarding individually identifiable health information.
All requests related to these items must be made in writing to the Practice’s Privacy Officer at the address listed below. The Practice will provide you with the appropriate forms to exercise these rights. The Practice will notify you in writing if your requests cannot be granted.
- Restrictions on Use and Disclosure: You have the right to request restrictions on how we use and disclose your health information. This right includes requests to restrict disclosure of your health information only to certain individuals or entities involved in your care, such as family members and/or insurance companies. The Practice is not required to agree with your request. If the Practice agrees, we are bound to the agreement, unless disclosure is otherwise required or authorized by law.
- Confidential Communications:You have the right to request that the Practice communicate with you in a particular manner or at a certain location. For example, you may request that we only contact you at home. The Practice will accommodate reasonable requests.
- Access: You have the right to inspect or request a copy of records used to make decisions about your health care, including your medical chart and billing records. The office of the Practice will schedule appointments for record inspection. The Practice may charge a fee for providing you copies of your records. Under special circumstances, we may deny your request to inspect and/or copy your records. You may request review of such denial.
- Record Amendments: You may have the right to request amendments to your health records created by and for the Practice, if you feel they are incorrect or incomplete. The Practice may accept or deny your request. If the request is denied, you have the right to provide a statement of disagreement or rebuttal statement.
- Accounting of Disclosures: You have the right to receive an accounting of the disclosures, meaning you may request a list of certain disclosures the Practice has made of your records. Upon your request, the Practice will provide this information to you one time at no charge once each twelve (12) month period. Fees may be assessed for additional copies.
- Copy of Notice: You have the right to request that the Practice provide you a paper copy of this Notice of Privacy Practices.