We are required by law to maintain the privacy of our patients’ protected health information and to provide patients with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice for as long as it remains in effect.
We are dedicated to protecting your “nonpublic personal health information.” This will inform you how and why we collect that information and who has access to that information.
How We Collect Your Information
Your personal demographic information, such as name, address, birthdate, social security number, and medical insurance information, is obtained from you. To ensure this information is correct, we ask you to fill out a registration form and provide us with a copy of your driver’s license and insurance card. When you come to our practice through another agency, we may obtain that information from the agency. However, on your first visit to the office, we will ask you to complete a Release of Information in order to maintain correspondence with that agency.
When you come to our practice through another agency, we may obtain that information from the agency. However, on your first visit to the office, we will ask you to complete a Release of Information in order to maintain correspondence with that agency.
We may also ask another individual/agency that referred you to give us information that will enable us to better treat you. This benefits you in that we will have information that has already been obtained by the referring entity.
Why We Collect This Information
We collect this information so that we can treat your medical condition and obtain payment from you or your health insurance.
Who Has Access To This Information
Any person or persons you designate in writing are entities that have access to your Protected Health Information. Some of these people may include people directly involved in your treatment, people creating and maintaining your medical records, and those entities that need your information to process health care claims and obtain payments for our services.
How We Protect Your Information
We release your information only to those people who need your information to provide adequate treatment for you. We maintain physical and procedural safeguards so that only the persons involved in your case, or entities that need this information for claims processing, have access to your Protected Health Information.
You have the right to inspect your Protected Health Information. You also have the right to amend any errors you may find in your record. When you leave our agency, your PHI will continue to receive the protections outlined in this notice.
If you have any complaints concerning our privacy practices, please contact a privacy officer at this agency at (928) 445-0744.
You may also contact:
The Secretary of the Department of Health and Human Services
200 Independence Ave S.W. Room 509F, HHH Building, Washington, D.C. 20201