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.
“Protected Health Information” (PHI) is information about you, including demographic information, that may identify you and relate to your past, present, or future physical or mental health or condition and related health care services.
Priority Medical Group is required by law to maintain the privacy of your PHI and provide you with this notice of our legal duties and privacy practices concerning your protected health information and your rights to access and control it. We reserve the right to change the terms of this notice and will notify you of such changes. You then have the right to object or withdraw as this notice provides. Please get in touch with our Privacy and Security Officer if you have any questions or objections to this form.
Your PHI may be used and disclosed by your healthcare provider, our office staff, and others outside of our office who are involved in your care and treatment to provide healthcare services to you, pay your healthcare bills, support the operation of the physician’s practice, and any other use or disclosure required by law.
We will use and disclose your PHI to provide, coordinate, or manage your health care and related services. This includes coordinating or managing your health care with a third party. For example, we would disclose our PHI, as necessary, to a home health agency that provides care to you. For example, your PHI may be provided to a physician to whom you have been referred to ensure the physician has the necessary information to diagnose or treat you.
Your PHI will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the hospital admission.
We may use or disclose, as needed, your PHI to support the business activities of this practice. These activities include but are not limited to, quality assessment activities, employee review activities, training medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your PHI to medical school students that see our patients. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.
We may use or disclose your protected health information in the following situations without your authorization.
Other Uses and Disclosures which require authorization.
Unless required by law, disclosure of your PHI in the situations below and any others not described in this notice will be made only with your consent, written authorization, or the opportunity to object. You may revoke your authorization in writing at any time, except that your physician or the physician’s practice has acted in reliance on the use or disclosure indicated in the approval.
Other Uses and Disclosures which require authorization.
Following is a statement of your rights concerning your protected health information, subject to certain limitations. Requests related to your PHI should be made to our Privacy and Security Officer. You have the right to:
Inspect and copy your PHI in “designated record sets” under your request (reasonable fees may apply). You may request an electronic copy of your medical records, and we will try to provide the records in the format you request. “Designated record sets” contain medical and billing records and other records the practice uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of or used in a civil, criminal, or administrative action or proceeding; and PHI that is subject to laws that prohibit access.
Request a restriction of your PHI. You may ask us not to use or disclose any part of your PHI for treatment, payment, or healthcare operations. You may also request that any part of PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want that restriction to apply. Your physician is not required to agree to a restriction. If our physician believes it is in your best interest to permit the use and disclosure of your PHI, it will not be restricted. You then have the right to use another healthcare professional.
Request to receive alternative communication from us. You can request confidential communications from us or at an alternative location.
You have the right to obtain a paper copy of this notice from us upon request, even if you have agreed to accept it alternatively, i.e., electronically.
Have your physician amend your PHI. If we deny your request for amendment, you have the right to file a statement of disagreement with us, and we may prepare and provide you with a copy of our rebuttal to your statement.
Receive an accounting of certain disclosures we have made, if any, of your PHI for purposes other than treatment, payment, health care operations, notification and communication with family and friends, and those required by law.
Receive a notice of breach if a breach of your unsecured protected health information occurs.
Complaints
You may complain to us or the Secretary of the United States Department of Health and Human Services if you believe we have violated your privacy rights. If you wish to file a complaint with us, please submit it via telephone, email, or in writing to our Privacy and Security Officer. We will not retaliate against you for filing a complaint.