PLEASE REVIEW 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 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.

Example:

A nurse or medical assistant obtains treatment information about you and records it in a health record.

During the course of your treatment, the physician determines he/she will need to consult with another specialist in the area. He/she will share the information with such specialist

And obtain his/her input.

Example of use of your health information for payment purposes:

We submit requests for payment to your health insurance company. The health insurance company or business associate helping us obtain payment requests information from us regarding your medical care given. We will provide information to them about you and the care given.

Example of Use of Your Information for Health Care Operations:

We may obtain services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such business associates as necessary to obtain these services.

Your Health Information Rights

The health and billing records we maintain are the physical property of the doctor’s office. You have the following rights with respect to your Protected Health Information.

Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office—we are not required to grant the request but we will comply with any request granted;
Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”} by making a request at office;
Right to inspect and copy your health record and billing record—you may exercise this right by delivering the request in writing to our office; appeal a denial of access to your protected health information except in certain circumstances;
Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office. {The physician or other health care provider is not required to make such amendments}; you may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
Right to receive an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
Right to confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office, and,
If you want to exercise any of the above rights, please contact:

Name: Stephanie June, Office Manager, UWS

Address: 102 Central Ave,

Telephone: (423) 756-4796 ext. 16

In person or in writing, during normal business hours. She will provide you with assistance on the steps to take to exercise your rights.

Our Responsibilities

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 of 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 Stephanie June Telephone (423) 756-4796.

Additionally, if you believe your privacy rights have been violated, you mat file a written complaint at our office by delivering the written complaint to Stephanie June. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services,

We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.