Home > Notice of Patient Privacy Practices

Notice of Patient Privacy Practices

YOUR HEALTH INFORMATION Rights

Although your health record is the physical property of the facility that compiled it, you have the right to:

INSPECT AND COPY: You have the right to inspect and copy medical information that may be used to make decisions about your care. We ask that you submit these requests in writing. Usually, this includes medical and billing records, but does not include psychotherapy notes or information compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action or proceeding. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Requests for access to and copies of your medical information must be submitted to Joanne Marian, DMD in writing. There is no charge for release of PHI.

AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information by submitted a request in writing. You have the right to request an amendment for as long as we keep the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.

AN ACCOUNTING OF DISCLOSURES: You have the right to request an accounting of our disclosures of medical information about you except for certain circumstances, including disclosures for treatment, payment, health care operations or where you specifically authorized a disclosure. Joanne Marian DMD will provide the first accounting to you in any 12 month period without charge. The cost for subsequent requests for an accounting within the 12 month period will be no charge. We ask that you submit these requests in writing.

REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had. We ask that you submit these requests in writing.

EXCEPT UNDER SPECIFIC CIRCUMSTANCES, WE ARE NOT REQUIRED TO AGREE TO YOUR REQUEST. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment or is required by law. We must agree to restrict the disclosure of protected health information to a health plan for purposes of carrying out payment or health care operations (as defined by HIPAA) if the information pertains to a health care item or service for which we have been paid by your out-of-pocket, and in full.

Page 1 | Page 2 | Page 3 | Page 4 | Page 5

Copyright © 2016 WebSpinnery All Rights Reserved