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Untitled Document
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.
The Health Insurance Portability & Accountability Act of
1996 ("HIPAA") is a federal program that requires that all medical
records and other individually identifiable health information used or disclosed
by us in any form, whether electronically, on paper, or orally, are kept properlyconfidential.
This Act gives you, the patient, significant new rights to understand and control
how your health information is used. "HIPAA" provides penalties for
covered entities that misuse personal health information.
As required by "HIPAA", we have prepared this explanation
of how we are required to maintain the privacy of your health information and
how we may use and disclose your health information.
We may use and disclose your medical records only for each of
the following purposes: treatment, payment and health care operations.
- Treatment means providing,
coordinating, or managing health care and related services by one or more
health care providers. An example of this would include teeth cleaning services.
- Payment means such activities
as obtaining reimbursement for services, confirming coverage, billing or collection
activities, and utilization review. An example of this would be sending a
bill for your visit to your insurance company for payment.
- Health care operations
include the business aspects of running our practice, such as conducting quality
assessment and improvement activities, auditing functions, cost-management
analysis, and customer service. We will not, however, use your medical information
for marketing communications without your written consent. An example would
be an internal quality assessment review.
We may also create and distribute de-identifiable health information
by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information
about treatment alternatives or other health-related benefits and services that
may be of interest to you.
Any other uses and disclosures will be made only with your written
authorization. You may revoke such authorization in writing and we are required
to honor and abide by that written request, except to the extent that we have
already taken actions relying on your authorization.
You have the following rights with respect to your protected
health information, which you can exercise by presenting a written request to
the Privacy Officer:
- The right to request
restrictions on certain uses and disclosures of protected health information,
including those related to disclosures to family members, other relatives,
close personal friends, or any other person identified by you. We are, however,
not required to agree to a requested restriction. If we do agree to a restriction,
we must abide by it unless you agree in writing to remove it.
- The right to reasonable
requests to receive confidential communications of protected health information
from us by alternative means or at alternative locations.
- The right to inspect
and copy your protected health information. We reserve the right to charge
a cost-based fee for duplicating and postage.
- The right to amend your
protected health information.
- The right to receive
an accounting of disclosures of protected health information.
- The right to obtain
a paper copy of this notice from us upon request.
We are required by law to
maintain the privacy of your protected health information. This notice is effective
as of April 14, 2003 and we are required to abide by the terms of the Notice
of Privacy Practices currently in effect. We reserve the right to change the
terms of our Notice of Privacy Practices and to make the new notice provisions
effective for all protected health information that we maintain. We will post
and you may request a written copy of a revised Notice of Privacy Practices
from this office. You have recourse if you feel your privacy protections have
been violated. You have the right to file written complaint with our office
or with the Department of Health and Human Services, Office of Civil Rights,
about violations of the provisions of this notice or the policies and procedures
of our office. We will not retaliate against you for filing a complaint.
Please contact us for more information:
Pat Brush, Contact Officer
9825 E. Bell Road., Ste. 140, Scottsdale, AZ 85260
480-889-1800
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Patient Center
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