NOTICE OF PRIVACY PRACTICES
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 CAREFULLY
You have a right to confidentiality of personal health information (PHI) provided by
you to us, and/or created by use in connection with health care services rendered to you.
In this regard, under applicable federal privacy laws, you have the right, subject to
certain exceptions and limitations, to:
- Receive a paper copy of the form of notice of our information practices.
- See and obtain a copy of your own health information. (If reviewing record, it must
be supervised visit.)
- Request an amendment of the health information in your file, if you believe it is
inaccurate;
- Submit a written statement regarding the contents of your medical record, if we
disagree to your request for an amendment;
- An accounting of certain disclosures made by this office of your PHI over the past
six years, other than disclosures regarding treatment, payment, or health care operations
purposes. The covered disclosures essentially include those made without an authorization
for public interest or benefit purposes such as research, or in the context of legal
proceedings or if made in response to compliance and investigation reviews;
- Request restrictions, other than regarding emergency circumstances, on the allowable
uses of disclosures of your PHI. Such restrictions may include prohibitions on disclosure
of certain types of PHI or certain persons you do not wish to have access to your PHI.
This facility has the right to deny such a request however.
Note that this facility:
- May use your protected personal health information, without separate consent or
authorization from you, for treatment, payment of facility operations in connection with
services rendered by us, to you. For example, we may provide your personal health
information to your insurance plan, so support our request for reimbursement. We may also
disclose your PHI to family members and close friends involved in your care.
- May be required to disclose your PHI, without your consent or authorization, if required
by law. For example, the law requires that certain PHI be disclosed in connection with
protection of public health, for governmental health oversight activities, in response
to a valid subpoena or other judicial process, in response to certain law enforcement
inquiries, or to lesson a serious and imminent threat to the health and safety of a per
or the public.
- May discuss your treatment with other practitioners or clinicians involved in your care.
- 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.
Uses and disclosures other than those specifically referenced above or otherwise allowed by
law, will be made only with your written authorization and you may revoke such authorization,
in writing, at any time.
Marketing Materials - You will not receive any marketing
materials from us, unless we first receive a separate written consent form, executed by you,
allowing us to provide you with such information.
Changes to the Notice - This facility may change the
terms of this written notice and may make the new notice provisions effective for all
PHI that we maintain. If we do so, we will provide you with a copy of the revised notice at
the time of your receipt of health care services from this office, and we will post the notice,
with the effective date, in a visible location in this office.
Complaints - You may complain to us and to the
Secretary of the United States Department of Health and Human Services if you believe your
privacy rights have been violated. If you have any questions about this, or wish to file a
complaint with this office, you may contact Mary Lynne Boardman, the Office manager at 207-363-8430,
or you may submit a written complaint to this office directed to the same
person.
York Family Practice is required by law to abide by the terms of this notice
currently in effect.
You have the right to receive a copy of this notice. If one has not already been provided
to you, please ask and we will give you one.
The effective date of this Notice is February 1, 2008.