Patient's Statement of Privacy Rights
As a patient of this practice, you have the right to privacy of your Personal Health Information, and to know that such information shall be properly and securely maintained by this practice, in accordance with our own policy and in compliance with the Health information Accountability and Portability Act of 1996 (HIPAA HIPAA was enacted to give you, the patient of a health care provider and covered under an health insurance claim, more control over your health information, to set boundaries on the use and release of health records, establish appropriate safeguards that health care providers and others must achieve to protect the privacy of Personal Health Information, and to hold violators accountable, with appropriate penalties for violation of a patient's right to privacy.
AS A PATIENT OF THIS PRACTICE:
1. You are entitled to an individually delivered, written notification of your Privacy Rights at the time of your first visit to this practice's facility. The document you are reading is this notice.
2. You are entitled to see your medical records.
3.You are entitled to receive a copy of your medical records. (Forms are available upon request As per allowance by HIPAA the charge will be $0.10 per page.
4. You are entitled to make an amendment to your Patient Health Information within those records.
5. While the provider has a right to deny inclusion of amendments into a patient file, you have the right to disagree with the doctor's refusal of such inclusion of amendment to those records. (Forms are available upon request If the provider disagrees, he or she shall supply you with written notification of such disagreement. 6. You have the right to specify how access to your health information is restricted from whom.
7. You have the right to indicate the method and/or phone numbers and/or addresses to which telephonic and written communications to you shall be forwarded.
8. No Personal Health Information shall be given out to any entity not related to your treatment and the billing of medical services rendered, without your written authorization.
9. You are entitled to this practice's best efforts to maintain the security of Personal Health Information on your behalf within and outside this office.
10.This practice shall provide Personal Health Information to required parties on the basis of the minimum necessary standard of release (releasing only that information necessary for those parties to provide treatment, reimbursement, or administrative services on your behalf), and so as to maintain the intent of HIPAA in establishing that standard.