Privacy Policy

This notice describes how your medical records may be used and disclosed in agreement with the HIPAA regulations, the Health Insurance Portability and Accountability Act that is now in effect.

Please, review the policy carefully and contact our staff if you have any questions.  The new legislation introduces strict regulations regarding access to your medical records.  Thus, there is increased protection to you regarding this information but at the same time there are new limitations on its distribution.  Your medical records in this office contain information about your care and evaluation by the physician.  It will contain results of medical tests, letters mailed to us from you, communications with your insurance company.

Disclosure of Information.  We are allowed and entitled to disclose medical information about you to doctors, nurses, technicians and any other individuals that are involved in taking care of you.  For payment of our services we may disclose medical information to the insurance company or third party.  Your health plan may receive information about your treatment to obtain approval for a test or to determine whether your plan covers a particular treatment.  Medical information may be disclosed to the staff of the office.  Medical information about you will be released when required by federal, state or local law.  Medical information may be released when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.  If you are involved in a lawsuit or a dispute, medical information will be released in response to a court or administrative order.  Medical information may be released if asked to do so by a law enforcement official, coroner or medical examiner.

You may request release of your records to any person, agency, organization or family member provided the proper release is submitted in writing.

Your Access to Your Medical Records.  You have a right to inspect or receive copies of your medical records.  To do so, you must submit your request in writing to the office.  An appointment will be made for you to get access to the records in a supervised setting.  You may request release of records generated by this office.  However, records forwarded to this office generated by other offices will not be released to you or any other health professional.  Copies of your medical records will always be made available within seven days but will usually not be made available on the date of the request.  Copies will be charged at a few of $.75 per page.  There will be a charge for mailing.  Records of no more than ten pages will be charged at $1.00 per page.  Records released to health care professionals involved in your care at the time of the service will be copied and mailed free of charge.  Such records, if you should wish them faxed, will be charged to you at $1.00 per page, not to exceed ten pages.  In special circumstances, we may deny your request to inspect and copy your medical records.  If you are denied access to your records, you may request that the denial be reviewed.

Changes of Your Medical Records.  You have a right to amend your medical records, if you feel that they contain incorrect or incomplete information.  Any request for amendment must be made in writing and submitted to the office.  You must provide a reason that supports your request.  The request may be denied if it is not in writing and does not include a reason to support the request.  Your request will always be denied if the information was not created by us, if it is not part of the medical information kept by the office, if it is not part of information that you are not permitted to inspect and copy, of if the information is accurate and complete.  You do not have a right to take possession of your medical records or request that they be destroyed.  You do not have a right to refuse submission of the medical records to your personal physician or the physician that referred you to this office.

Information amended at your request will usually require a written attachment, typed and signed by you, that will be appended to the medical records.  Medical information that is already part of your records will only in very exceptional circumstances be deleted.  For example, typing errors or frankly incorrect information such as your age, date of birth, spelling of name.  You are not entitled to request changes in the doctor's diagnosis or impressions.  However, should you disagree with these, you are entitled to append the typewritten signed letter stating the reason for your disagreement.

Agreement of Disclosures.  You have the right to request "accounting of disclosures".  This is a list of disclosures made of your medical information to various sources.  Your request must be submitted in writing.  It must state a time period which may not be loner than six years and it may not include dates prior to April 2003.  The first list you request within the 12 month period from the first visit to this office will be free, any additional lists will be charged, prepaid, for the cost of providing the list.

Limitations on Disclosures.  You have the right to request a restriction of medical information.  To request restrictions you must make the request in writing, specifying which information you want to limit, to whom you want the limits to apply.  We are not required to agree with your request.

You have the right to request that we communicate with you in a certain way or at a certain location.  If you leave a phone number, we may leave a message that the doctor tried to reach you.  If you leave a fax number (or email address), we assume that confidential information can be forwarded to this number.  Request for information from family members will be ignored, unless you have provided the office with a written authorization for the office to communicate with a particular family member.  Only one family member will be contacted.  The request should be written in agreement with the rules outlined above.  Family members will be informed about your condition by telephone or in person without signed consent under the following circumstances:  if patient is a minor, if patient is with limited mental competence, if patient is seriously ill in the hospital, if patient for any other reason is unable to communicate with his family.  Communications between physician and family members will be limited to the closest next of kin.

Change of Privacy Policy.  We reserve the right to change the current policy with retroactive effect.  If you believe your privacy rights have been violated you may file a complaint with our office or with the Department of Health and Human Services.  Any complaint to this office should be submitted in writing.  You will not be penalized for filing a complaint.  Any permission that you make for disclosure or restrictions of disclosure may be changed by you in the future if submitted in writing.  Any disclosure already made, of course, cannot be retracted.

Termination of Care.  You may terminate visits with and treatments by the doctor at any time.  Please notify us of your decision by letter or a phone call.  You are not required to give any reason for doing so.  Your records will be kept in storage for seven years, as required by law.  The physician may terminate your care by sending a certified letter.  Emergency care will be provided for one month hereafter.  The doctor does not have to explain to you the reasons for the termination.

Acknowledgement of Receipt of this Privacy Notice with your pledge to read it will be maintained on the list of "Accounting of Disclosures".