PROVIDER/CLINIC OBLIGATIONS
- We are providing you with this notice regarding our legal duties and privacy practices related to your health information.
- Maintain the privacy of protected health information.
- Follow the terms of our notice that are currently in effect.
- Please note that we may communicate with you via email or text message on your cell phone.
- Notify you of a breach of protected information as required by federal and state law.
PROTECTED HEALTH INFORMATION
Protected health information is defined by HIPAA as individually identifiable health information; it can be verbal, written or electronic.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION
The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such consent at any time by writing to our practice’s Privacy Officer, Olivia Polselli
For Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care. This ensures that you receive optimal treatments that are safe for you, tailored to your personal medical history.
For Payment. We may use and disclose Health Information so that we or others may bill and receive payment from you. For example, we offer payment services through Advance Credit.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose Health Information to contact you to remind you of an upcoming appointment with us. We may also use and disclose Health Information to inform you about treatment alternatives, health-related benefits, and services that may be of interest to you. When appropriate, we may share Health Information with a person involved in your medical care or payment for your care, such as a family member or close friend. In the event of an emergency, we may also notify your designated emergency contact about your location or general condition.
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT OUT
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify as your emergency contact, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best medical interest.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
Uses and disclosures of Protected Health Information for marketing purposes.
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you authorize us, you may revoke the authorization at any time by submitting a written revocation to our office, and we will no longer disclose Protected Health Information under the authorization. However, the disclosure that we made in reliance on your approval, before its revocation, will not be affected by the revocation.
YOUR RIGHTS
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a specific manner or at a designated location. For example, you can request that we only contact you by mail or at your workplace. To request confidential communications, please submit your request in writing to Olivia Polselli. Your request must specify how you wish to be contacted (e.g., by telephone) and whether we are allowed to leave voicemails, emails, or text messages. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to update this notice in accordance with any changes made to the HIPAA Notice of Privacy Practices.
Your privacy is of the utmost importance to us. If you have any questions about our privacy policy, please don’t hesitate to contact our office at your earliest convenience.