NOTICE OF PRIVACY PRACTICES OF PATRICK COUNTY FAMILY PRACTICE, P.C.
(Effective date: 4/01/03)
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.
Uses and Disclosures of Health Information
With your consent, we may use individually identifiable protected health information ("Information") about you for treatment (such as sending your medical record to a specialist physician as part of a referral), to obtain payment for treatment (such as sending billing information to a health insurance plan), for administrative purposes, and to evaluate the quality of care that you receive (such as comparing patient data to improve treatment methods).
We may use or disclose Information about you without your Authorization for several other reasons. Subject to certain requirements, we may give out Information without your Authorization for public health purposes, abuse or neglect reporting, auditing purposes, research studies, funeral arrangements and organ donataion, workers' compensation purposes, and in emergencies. We provide Information when otherwise required by law, such as for law enforcement in specific circumstances. We may also contact you about appointment reminders or treatment alternatives.
In any other situation, we will ask for your written Authorization before using or disclosing any Information about you. If you choose to sign an Authorization to disclose Information, you can later revoke that Authorization in writing to stop any future uses and disclosures.
We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the waiting area and in each examination room. You can also request a copy of our Notice at any time. For more information about our privacy practices, please contact the person listed below.
In most cases, you have the right to review or receive a copy of Information about you that we use to make decisions about you. If you request copies, we may charge you $35 (see Authorization Policy for Virginia's limitations on charges). You also have the right to receive a list of instances where we have disclosed Information about you for reasons other than when you have already specifically authorized the disclosure, or for treatment, payment, or related administrative purposes. If you believe that Information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. We are not require to comply with your request, however, if we deny your request we will provide you a written explanation of the basis for the denial and give you the right to file a written statement of disagreement and further explain the complaint process.
You also have the right to request that your Information be communicated to you in a confidential manner, such as sending mail to an address other than your home. If this Notice was sent to you electronically, you have the right to request a paper copy of the Notice and if this Notice is later revised, you also have the right to request a paper copy of the revised Notice.
You may request in writing that we not use or disclose your Information for treatment, payment, or administrative purposes or to persons involved in your care except when specifically authorized by you, when required by law, or in emergency circumstances or request other restrictions on use or disclosure of Information. We will consider your request but we are not legally required to accept it.
If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records or the other individual rights listed in this Notice, you may also send a written complaint to the attention of the Secretary of the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request. Under no circumstances will you be retailiated against for filing a complaint.
Our Legal Duty
We are required by law to protect the privacy of your Information, provide this Notice about our information practices, and follow the information practices that are described in this Notice.
If you have any questions or complaints, please contact:
Patrick County Family Practice, P.C.
18877 JEB Stuart Hwy.
Stuart, VA 24171