Notice of Privacy Practices
Pikes Peak Nephrology Associates, P.C.
Effective date: February 19, 2021 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. We welcome any questions you may have to assist in understanding this document. Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our website or we will mail a copy to you upon request.
Your Rights : When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record 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 information, usually within 30 days of your request. We may charge a reasonable, cost-based
Ask us to correct your medical record
You can ask us to correct health information about you that you think is 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.
Request confidential communications
You can ask us to contact you in a specific way about your medical information (for example, home or office phone) or to send your medical information to a different address.
We will say, "yes" to all reasonable requests.
Ask us to limit what we use or share
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 pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.
Get a list of those with whom we've shared information
You can ask for a list (accounting) of the times we've shared (disclosed) your health information, for up to 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 healthcare 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
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices aboutyour health information. We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can file a complaint with us if you feel we have violated your rights by contacting our Privacy Officer. To file a complaint with our organization, please submit your request in writing to the Privacy Officer Robin Largin 1914 Lelaray St, Colorado Springs, CO, 719-632-7641, firstname.lastname@example.org You can file a complaint with the U.S. Department of Health and Human Services' Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/ We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, contact us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to: Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory
If you are not able to tell us your preference for example, if you are unconscious, we may share your information if we believe it is in your best interest to do so.
We may also share your information when needed to lessen a serious and imminent threat to health or safety.