THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ CAREFULLY.
Our practice collects personal health information on you that may be used for three purposes:
1. Treatment -- For example, we will prepare a record of information each time about you in or out of the office while you are under our care. This medical record is used to keep track of changes in your condition as well as remind us of your past medical treatment, allergies, and other facts relevant to your overall health. This information may be passed on to other providers as part of a coordinated health care program for you.
2. Payment -- We must report elements of your personal health information, such as specific treatments, visits, tests, and surgeries along with related diagnoses to third-party payers to properly determine benefits payable on your behalf for the services we render. We only report the minimum necessary information to process these.
3. Health Care Operations -- In order to provide you with high-quality healthcare, we often need to be able to your personal health information for purposes such as pre-registering you at the hospital if you ever need to be admitted or providing the pharmacy with your information for a prescription so that it is ready to pick up when you arrive. We will call you by name when the physician is ready to see you. We may use or disclose your protected health information if necessary to contact you with test results or remind you of your appointment. Again, we are committed to using the minimum necessary information to achieve these purposes.
In addition, we will use or disclose your personal health information under the following circumstances:
When we receive a valid authorization from you
If you give us oral authorization
If we are required by law to disclose your information to other public health agencies
We are required to disclose the information to you if you request it and we are required to disclose the information to the US DHHS for compliance determinations of this practice. We may disclose information about you without your authorization for the following reasons:
When required by law, for judicial proceedings or law enforcement
For workers compensation
For uses and disclosures about descendents
Uses and disclosures for cadaveric tissue donation
To avert a serious threat to public health or safety
Disclosures about abuse or neglect or domestic violence
Information to the military or government if required by law
Other uses and disclosures will be made only with your written authorization and you may revoke such authorization by writing to us at our practice address or delivering a written revocation to us in person.
You have a right to request restrictions on the use and disclosure on the use and disclosure of your personal health information. Our practice is not obligated to accept your restrictions though. However, if we do accept the restriction it must be complied with fully on our part.
You have the right to request that you receive your health information in a specific way at a specific location. We will comply with all reasonable requests submitted in writing where it is specified how or where you wish to receive these communications. We will not ask for an explanation regarding the basis for the request.
You have the right to inspect and have a copy of your personal health information. If you would like a copy, please request the information in writing or use a form available in our office for the request.
You have a right to request amendments to your personal information. We will not amend any information we did not create. We are not obligated to make an amendment to your personal health information but we will include your request for the amendment as part of your personal health information.
You have a right to an accounting for the prior six years (but no earlier than the effective date of this notification) for uses and disclosure purposes other than treatment, payment and health care operations of our practice.
You have a right to a paper copy of this notification, and the current version will be provided to you at your request. It may also be viewed at our website, at www.drldiego.com.
We are obligated by law to protect your privacy and we will do out utmost to fulfill this duty for you. We will abide by all the terms in this notification but we reserive the right to change the terms of this notice and the personal health information it protects. You are entitled to know of those changes. We will post any changes in the office, and we will include the updates with statements mailed to patients.
We will do our very best to make certain you rights are protected as we carry out our responsibilities to you.If you have any complaints, we encourage you to contact us. It is our sincere desire to preserve your privacy and fulfill our duties. We will take no retaliatory actions against any person for exercising their right to the resolution of a grievance. If we cannot resolve the issue for you, you have the right to file a grievance and make a complaint to the Department of Health and Human Services.
To make a complaint or ask any questions concerning this policy, please contact Dr. Diego directly at (213) 388-2229.
