Notice of Privacy Practices
DO NOT PUBLISH AS-IS. A HIPAA Notice of Privacy Practices is a legally required document specific to your practice. The outline below shows the required sections; the final text must be prepared or reviewed by your compliance advisor or attorney, and the effective date completed.
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.
Effective date: TODO
Our commitment
Chavez & Mederos Clinic is required by law to maintain the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
- Treatment — to provide, coordinate or manage your care, including with other providers involved in your treatment.
- Payment — to bill and collect payment from you, an insurance company or a third party.
- Health care operations — for quality assessment, staff review, training, licensing and business management.
- As required by law — including public health reporting, health oversight, judicial proceedings and law enforcement in the circumstances the law specifies.
Your rights
- To inspect and obtain a copy of your health record
- To request an amendment to your record
- To request an accounting of certain disclosures
- To request restrictions on certain uses and disclosures
- To request confidential communications by alternative means or at an alternative location
- To receive a paper copy of this notice
- To be notified in the event of a breach of your unsecured health information
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the clinic or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
TODO: privacy officer name, address, phone and email