Siouxland OB/GYN, P.C
2730 Pierce Street, Suite 201, Sioux City, IA 51104
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.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is
a federal program that requires that all medical records and other individually
identifiable health information used or disclosed by us in any form, whether
electronically, on paper, or orally, are kept properly confidential. This Act
gives you, the patient, significant new rights to understand and control how
your health information is used. HIPAA provides penalties for covered entities
that misuse personal health information. As required by HIPAA, we have prepared
this explanation of how we are required to maintain the privacy of your health
information and how we may use and disclose your health information. We may
use and disclose your medical records only for each of the following purposes:
treatment, payment, and health care operations.
Treatment means providing, coordinating, or managing health care and related
services by one or more health care providers.
Payment means such activities as obtaining reimbursement for services, confirming
coverage, billing or collection activities, and utilization review. An example
of this would be sending a bill for your visit to your insurance company for
payment.
Health Care Operations include the business aspects of running our practice,
such as conducting quality assessment and improvement activities, auditing
functions, cost-management and analysis, and customer service. An example would
be an internal quality assessment review.
We may also create and distribute de-identified health information by removing
all references to individually identifiable information. We may contact you
to provide appointment reminders or information about treatment alternatives
or other health-related benefits and services that may be of interest to you.
Any other uses and disclosures will be made only with your written authorization.
You may revoke such authorization in writing and we are required to honor and
abide by the written request, except to the extent that we have already taken
actions relying on your authorization. You have the following rights with respect
to your protected health information, which you can exercise by presenting
a written request to the Privacy Officer:
- The right to request restrictions on certain uses and
disclosures of protected health information, including
those related to disclosures to family members, other relatives,
close personal friends, or any other person identified
by you. We are, however, not required to agree to a requested
restriction. If we do agree to a restriction, we must abide
by it unless you agree in writing to remove it
- The right to reasonable request to receive confidential
communications of protected health information from us
by alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an accounting of disclosures of
protected health information.
- The right to obtain a paper copy of this notice from
us upon request.
We are required by law to maintain the privacy of your protected
health information and to provide you with notice of our
legal duties and privacy practices with respect to protected
health
information. This notice is effective as of April 15, 2003,
and we are required to abide by the terms of the Notice of
Privacy Practices currently in effect. We reserve the right
to change the terms of our Notice of Privacy Practices and
to make the new notice provisions effective for all protected
health information that we maintain. We will post, and you
may request a written copy of a revised Notice of Privacy
Practices from this office. You have recourse if you feel
that your privacy
protections have been violated. You have the right to file
a written complaint with our office, or with the Department
of Health and Human Services, Office of Civil Rights, about
violations of the provisions of this notice or the policies
and procedures of our office. We will not retaliate against
you for filing a complaint. Please contact us for more information.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health and Human Services - Office of Civil Rights
200 Independence Avenue S.W.
Washington, DC 20201
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