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 properly confidential. 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 disclosing information to a case
manager who is responsible for coordinating your care.
·
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 our 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. An example would be an internal quality
assessment review.
We may also create and distribute de-identified
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.
We will disclose health information about you
when required to do so by Federal, State or local laws.
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
restriction 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
·
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 and to provide you with notice of our
legal duties and privacy practices with respect to 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 that your privacy
protections have been violated. You have the right to file written complaint
with our office or with the Department of Health & 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.
For more information about HIPAA or to file a
complaint:
| Edgar C. Almazan,
M.D. |
OR
|
The U.S.
Department of Health & Human Services |
| Privacy Officer |
|
Office of Civil Rights |
| Upper Manhatan
Mental Health Center, Inc. |
|
2000 Independence
Avenue, S.W. |
| 1727 Amsterdam Avenue |
|
Washington, D.C.
20201 |
| New York, N.Y. 10031
|
|
(202) 619-0257 |
| (212) 694-9200,
Extension 466 |
|
Toll Free:
1-877-696-6775 |
