Summary of Privacy Notice
The information contained in this summary is NOT a comprehensive explanation of the mandated HIPAA Privacy Notice. It is only meant to assist patients with a basic and general understanding of the privacy policies of this practice. Signing this DOES NOT replace your signature for the entire privacy notice. To view the complete HIPAA Privacy Notice, please click on the PDF file link above.
HIPAA is the Health Insurance Portability and Accountability Act of 1996. It is a federally mandated law that entitles the patient to protection of their Protected Health Information (PHI) and defines its acceptable uses for disclosure to others.
This practice or facility may use your demographic or medical PHI for the following reasons:
1. Treatment of any kind, including disclosure of information to outside business associates such as laboratories or other healthcare facilities or providers.
2. Payment of any service provided by the facility, any provider associated with this facility or any entity practicing as a business associate to this facility or its providers.
3. General Healthcare Operations such as employee training or quality assurance.
4. Any other reason required by law, public health reporting, research purposes or worker’s compensation compliance.
The reasons listed above are inclusive examples of the right to disclose, but are not a complete listing of this facilities or its providers’ rights to disclose.
HIPAA provides the patient with the right to request a restriction on the disclosure or usage of their PHI for any reason. All requests for restrictions must be made in writing to the facility’s Privacy Contact Person. However, a request for a restriction must not create an impediment to the care of the patient or the ability of the provider or facility to obtain payment for its services.
If a patient believes that there has been a violation of their privacy rights as defined by HIPAA, they have the right to file a complaint with the facility’s Privacy Contact, the Department of Health and Human Services (Office of Civil Rights), or both.