Notice of Privacy Practices for Protected Health Information
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!
Our office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
We may collect the following information:
- Name and job title
- Contact information including email address and social security number (when applicable)
- Demographic information such as postcode, preferences and interests
- Other information relevant to customer surveys and/or offers
We require this information to understand your needs and provide you with a better service, and in particular for the following reasons:
- Internal record keeping.
- We may use the information to improve our products and services.
- We may periodically send promotional email about new products, special offers or other information which we think you may find interesting using the email address which you have provided.
- From time to time, we may also use your information to contact you for market research purposes. We may contact you by email, phone, fax or mail.
- We are committed to ensuring that your information is secure. In order to prevent unauthorized access or disclosure we have put in place suitable physical, electronic and managerial procedures to safeguard and secure the information we collect online.
- If we file insurance for electronic payments your personal information will be transmitted to the insurance carrier. Your personal information may be disclosed to the CDC for research or public health purposes.
What rights you have over your data
- Persons can inspect and have a copy of their records.
- Persons must be told how their information is used and to whom it will be disclosed.
- Person’s permission is required in writing before sharing any information pertaining to treatment with others, except in case of emergency.
The office is required to:
- Maintain the privacy of your health information as required by law;
- Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
- Abide by the terms of this “Notice”;
- Notify you if we cannot accommodate a requested restriction or request; and
- Accommodate your reasonable requests regarding methods to communicate health information with you.
- Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our “Notice”. You are entitled to receive a revised copy of the “Notice” by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Dawn Barrom, Office Manager, (901-244-6631).
This information has been supplied in accordance to HIPAA regulations and your signature on the consent form verifies you have read and received a copy as requested or via web site containing this information.