NOTICE: HIPAA NOTICE OF PRIVACY PRACTICE Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. It also describes how your protected health information may be used or disclosed to carry out treatment, payment or healthcare operation or for any purposes that are permitted or required by law.
Your Rights
You have the right to: • Get a copy of your health and claims records
• Correct your health and claims records • Request confidential communication • Ask us to limit the information we share • Get a list of those with whom we’ve shared your information • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated You have some choices in the way that we use and share information as we: • Answer coverage questions from your family and friends • Provide disaster relief • Market our services and sell your information
Your Choices
Our Uses and Disclosures We may use and share your information as we: • Help manage the health care treatment you receive • Run our organization • Pay for your health services • Help with public health and safety issues • Do research • Comply with the law
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director • Address workers’ compensation, law enforcement and other government requests • Respond to lawsuits and legal action
When it comes to your health information, you have certain rights. • This section explains your rights and some of our responsibilities to help you.
YOUR RIGHTS
Get a copy of health and claims records
• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee. • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in writing within 60 days. • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not. • You can ask us not to use or share certain health information for treatment, payment or our operations. • We are not required to agree to your request, and we may say “no” if it would affect your care. • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with and why. • We will include all the disclosures except for those about treatment, payment and health care operations and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Ask us to correct health and claims records
Request confidential communications
Ask us to limit what we use or share
Get a list of those with whom we’ve shared information
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