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Full Color Motivational Safety Poster 18″ x 24″ Laminated<\/strong><\/p>\n

HIPAA HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT<\/p>\n

This notice describes how your medical information may be used and disclosed and how you can get access
\nto this information. Please review it carefully.<\/p>\n

Notice of Privacy Act
\nThis health provider is committed to keeping your personal health information confidential and secure. We will protect your Protected Health Information, or PHI, by maintaining privacy policies and procedures that meet or
\nexceed the requirements of the Health Insurance Portability and Accountability Act of 1996 (\u201cHIPAA\u201d). In this Notice, \u201cmedical information\u201d means the same as \u201chealth information.\u201d When you receive care from a provider, that provider may get health information about you. Health information includes any information that relates to (1) your past, present, or future physical or mental health or condition; (2) providing health care to you; or (3)
\nthe past, present, or future payment for your health care. This Notice tells you about your privacy rights, each provider\u2019s duty to protect health information that identifies you, and how each provider may use or disclose health information that identifies you without your written permission. This notice does not apply to health information that does not identify you or anyone else. The privacy policy and practices of the provider protect confidential health information that identifies you or could be used to identify you and relates to a physical or mental health condition or your payment of your health care expenses. This individually identifiable health information is known as \u201cprotected health information\u201d (PHI). Your PHI will not be used or disclosed without a written authorization from you, except as described in this notice or as otherwise permitted by federal and state health information privacy laws.<\/p>\n

Rights to Request Restrictions:
\nThe provider may use and may disclose your personal health information for treatment, such as treatment of physical or mental impairments, and for the billing of such services. Additionally, providers may create, obtain, and disclose PHI for health care operations and may use such information for accreditation purposes.
\nThese include use and disclosure:
\n\u2022 when required by law\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2022 about decedents
\n\u2022 for public health activities\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2022 for law enforcement
\n\u2022 for judicial & administrative proceedings\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2022 for victims of abuse, neglect, or domestic violence
\n\u2022 for cadaveric organ, eye, or tissue donation purposes \u2022 for specialized government functions
\n\u2022 to avert a serious threat to health or safety \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u2022 for health oversight activities
\n\u2022 for worker\u2019s compensation \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u2022 for research and soliciting funds
\n\u2022 for appointment reminders \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u2022 to notify you of treatment alternatives<\/p>\n

Rights to Amend Your Personal Health Information:
\nIf you believe that your PHI is incorrect or that an important part of it is missing, you have the right to ask to have your provider amend your PHI while it is kept by or for this provider. You must provide your request and your reason for the request in writing. The provider may deny your request if it is not in writing or does not include a reason that supports the request. In addition, the provider may deny your request if you ask them to amend PHI that:
\n(1) is accurate and complete;
\n(2) was not created by them, unless the person or provider that created the PHI is no longer available to make the amendment;
\n(3) is not part of the PHI kept by or for them; or
\n(4) is not part of the PHI which you would be permitted to inspect and copy.<\/p>\n

Rights to Inspect and Copy Your Personal Health Information:
\nYou may inspect and copy your PHI that is maintained in accordance with HIPAA privacy regulations. These requests must be made in writing to the Privacy Officer.
\nRights to a List of Disclosures:
\nYou have the right to an accounting of disclosures of PHI. Requests for this accounting must be made in writing to the Privacy Officer.<\/p>\n

Rights to Request Amendments:
\nIf you feel that your Health Information is incorrect or incomplete, you may ask your provider to amend the information and you must tell them the reason for your request. You have the right to request an amendment
\nfor as long as the information is kept by or for the provider. A request for amendments must be submitted, in writing, to the Privacy Officer.<\/p>\n

Changes to this Notice:
\nWe reserve the right to change the terms of this Notice. In that event this provider will make the revised notice applicable to all health records, regardless of whether the records were created before or after the revision to the Notice. The provider will make the changes available to our customers upon request.<\/p>\n

Complaints:
\nIf you believe your privacy rights have been violated in any way, you may file a complaint in writing with our HIPAA Privacy Contact Person. We will attempt to resolve your complaint promptly. Alternatively, you may complain to the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W. Washington, D.C. 20201, generally within 180 days of when the act or omission complained of occurred.
\nIf you have any questions or concerns regarding your protected health information, please ask to speak with
\nthis facility\u2019s Privacy Officer.<\/p>\n<\/div>\n