Notice of Privacy Practices HIPAA Act of 1996
This notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please read it
Purpose: This Notice of Privacy Practice describes how we may
use and disclose your Protected Health Information to carry out treatment,
payment or healthcare operations and for other purposes permitted or
required by law. Protected Health Information (PHI) is information that
may identify the patient and that relates to the patientís past, present
or future physical or mental health, and may include name, address, phone
numbers and other identifying information.
We are required to give you this notice and to maintain the privacy of
your Protected Health Information. We must abide by this notice, but we
reserve the right to change the privacy practices described in it. A
current notice will be available at our office for repeat viewing if such
need should arise.
If you believe that your privacy rights have been violated, you may
complain to us or the U.S. Secretary of Health and Human Services. To file
a complaint with us, you may send a letter describing the violation to the
clinic at 9101 Kanis Road, Suite 300, Little Rock, AR 72205. This will be
no retaliation for filing a complaint.
Who will follow this notice? This notice describes the practices
of Arkansas Fertility and Gynecology Associates healthcare professionals
and other employees involved in the healthcare delivery of the clinic.
Acknowledgement: You will be asked to sign an Acknowledgement of
receipt of this notice. The delivery of healthcare services will in no way
be conditioned upon the signing of this acknowledgement.
Your Privacy Rights. You have the following rights relating to
our protected health information:
- Obtain a copy of the current notice
- Inspect or obtain a copy of your records. Your request to obtain a
copy of your medical records must be in writing. You may be charged a
fee for the cost of faxing or mailing a copying your records.
- Request that we amend your record, if you feel the information is
incomplete or incorrect. We are allowed to deny this request in certain
circumstances and may ask you to put these request in writing and
provide a reason that supports your request.
- Request in writing a restriction on certain uses and disclosures of
your information. We are not required to agree to the requested
restrictions in all circumstances.
- Obtain a record of certain disclosures of your PHI
- Make a reasonable request to have confidential communications of PHI
sent to your by alternative means or at alternative locations.
- We will obtain your written permission for uses and disclosures of
your PHI that are not covered by this notice or permitted by law.
- Submit any written requests to inspect copy or amend your records to
the clinic address.
Our Responsibilities. We are required to protect your PHI, abide
by the terms of the Notice, and make the notice available to you and to
notify you if we are unable to agree to requested restriction of an
alternative means of communicating.
Examples of Uses and Disclosures:
We will use your PHI for treatment. Certain information
obtained by a nurse, doctor, or other healthcare worker will be put into
your record and used to plan and manage your treatment. We may provide
reports or other information to your doctor or other authorized person who
are involved in your care.
We will use your PHI for payment. A bill will be sent to
you and/or to your insurance company with information about your
diagnosis, procedures and supplies used.
Business Associates. We may share your PHI with outside
people or companies who provide services for us, such as typing physician
Notification. We may use or disclose your PHI to notify a
family member (i.e. spouse), close personal friend, or parent involved in
your care unless specifically instructed not to disclose information.
Contacts. We may contact you to provide appointment
reminders or tell you about our new treatments and services.
Food and Drug Administration (FDA). We may share your PHI
with certain governmental agencies like the FDA and CDC so they can recall
drugs or equipment.
Communicable Diseases. We may disclose your PHI to a
person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease, if
authorized by law to do so, such as a disease requiring isolation. We may
give your PHI to public health agencies who are charged with preventing or
controlling disease or injury or disability and as required by law.
As required by Law. We must disclose your PHI when
required by federal, state, or local law.
Abuse or Neglect. We must disclose your PHI to
governmental authorities that are authorized by law to receive reports of
suspected abuse or neglect.
Legal Proceedings. We may disclose your PHI in the course
of any judicial or administrative proceedings or in response to a court
order, subpoena, discovery request or other lawful purposes.
Required Uses and Disclosures. We must make disclosures
when required by the Secretary of the Department of Health and Human
safety to investigate or determine our compliance with the HIPAA Privacy
To Avoid Harm. We may use and disclose information about
you when necessary to prevent a serious threat to your health or safety of
the health or safety of the public or another person.
Research. Your PHI may be used for research purposes in certain
circumstances with your permission.