Privacy Notice
This notice describes how your personal protected health information
(PHI) might be used by this Agency. This notice describes how you might access
your information and how you can restrict its disclosure.
Our Pledge regarding Medical Information:
We realize that the personal medical information that we acquire during your
consent for services remains strictly confidential and may not be disclosed
without your written consent. This includes any identifiable information whether
it be oral, electronic or paper.
How We Might Use and Disclose Protected Health Information Treatment:
We may use and disclose PHI in order to provide or co-ordinate your
health care services. For example, your information may be disclosed to other
health care providers such as your doctor's office or the hospital.
Payment:
We may disclose PHI if we bill an insurance company that provides coverage for
your services. We may discuss PHI with a third part payer in order to seek prior
approval of potentially covered services.
Organizational Operations:
As an agency committed to the cost effective delivery of the highest quality
service, we may disclose your PHI in ongoing performance improvement so that
staff members might improve their skills. Individuals Involved in Your Care:
Unless your choose otherwise, we may disclose PHI to a family member, relative
or close personal friend identified by you.
Communications From Our Office:
We may contact you by phone and/or mail to let you know about any appointment
changes that may impact the services provided to you. Limited Uses When you
are Incapacitated: In a situation where you cannot object to PHI disclosure,
we will exercise professional judgement and disclose PHI. In the Event of a
Disaster: We may disclose PHI to other health care providers in an effort to
coordinate care and disaster relief. Special Situations Military Personnel:If
you are a member of the armed forces, we may disclose PHI as required by military
command personnel.
Workers' Compensation:
In accordance with state law, we may disclose PHI to Workers' Compensation or
similar programs that provide benefits for work related injuries or illnesses.
Public Health Risks:We may disclose PHI to public health authorities charged
with preventing, or controlling the population at large. This includes government
related abuse and neglect agencies if the disclosure protects actual or potential
victims.
Health Oversight Activities:
We may disclose PHI to a health oversight agency for activities authorized by
law, for example an audit or inspection.
Law Enforcement:
We may release PHI if requested by law enforcement officials in response to
a court order, subpoena or other lawful process. Judicial and Administrative
Proceedings: If you are involved in a lawsuit or legal dispute, we may disclose
PHI in response to a court or administrative order. We may release PHI to someone
else involved in the dispute by only after efforts have been made to inform
you of the request or protect the requested information.
Coroner, Medical Examiners and Funeral Directors:
We may disclose PHI to a coroner or health examiner. For example, this may be
necessary to identify a person or cause of death. Correctional Facility:If you
become an inmate of a correctional facility, or are in the custody of a law
enforcement official, we may disclose PHI.
To Avert a Serious Threat to Health or Safety:
We may release PHI when we believe in good faith that disclosure is necessary
to prevent a serious threat to your health and safety or to the health and safety
of the public. We may disclose PHI without your consent due to your condition
or the nature of the medical emergency.