NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable federal and provincial law to maintain the privacy of your healthinformation. We are also required to give you the Notice about our privacy practices, our legal
duties, and your rights concerning your health information. We must follow the privacy
practices that are described in this Notice while it is in effect. This Notice takes effect today, and
will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time,
provided such changes are permitted by applicable law. We reserve the right to make changes
in our privacy practices and the new terms of our Notice effective for all health information that
we maintain, including health information we created or received before we made the changes.
Before we make significant change on our privacy practices, we will change this Notice and
make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy
practices, or for additional copies of this Notice, please contact us using the information listed at
the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment and healthcare
operations. For example:
TREATMENT: We may use or disclose your health information to a physician or other healthcare
provider providing treatment to you.
PAYMENT: We may use and disclose your health information to obtain payment for services
we provide to you.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection
with our healthcare operations. Healthcare operations include quality assessment and
improvement activities, reviewing the competence or qualifications of healthcare professionals,
evaluating practitioner and provider performance, conducting training programs, accreditation,
certification, licensing or credentialing activities.
YOUR AUTHORIZATION: In addition to our use of your health information for treatment,
payment or healthcare operations, you may give us written authorization to use your health
information or to disclose it to anyone for any purpose. If you give us an authorization, you may
revoke it in writing at any time. You revocation will not affect any use or disclose your health
information for any reason except those described in this Notice.
TO YOUR FAMILY AND FRIENDS: We must disclose your health information to you, as described
in the Patient Rights section of this Notice. We may disclose your health information to a family
member, friend or other person to the extent necessary to help with your healthcare or with
payment for your healthcare, but only if you agree that we may do so.
PERSONS INVOLVED IN CARE: We may use or disclose health information to notify, or assist in
the notification of (including indentifying or locating) a family member, your personal
representative or another person responsible for your care, of your location, your general
condition, or death. If you are present, then prior to use of disclosure of your health
information, we will provide you with an opportunity to object to such uses or disclosures. In
the event of your incapacity or emergency circumstances, we will disclose health information
based on a determination using our professional judgment disclosing only health information
that is directly relevant to the person’s involvement in your healthcare. We will also use our
professional judgment and our experience with common practice to make reasonable
inferences of your best interest in allowing a person to pick up filled prescriptions, medical
supplies, x-rays or other similar forms of health information.
MARKETING HEALTH-HEALTH RELATED SERVICES: We will not use your health information for
marketing communications without your written authorization.
REQUIRED BY LAW: We may use or disclose your health information when we are required to
do so by law.
ABUSE OR NEGLECT: We may disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the
possible victim of other crimes. We may disclose your health information to the extent
necessary to avert a serious threat to your health or safety or the health or safety of others.
NATIONAL SECURTIY: We may disclose to military authorities the health information of Armed
Forces personnel under certain circumstances. We may disclose to authorized federal officials
health information required for lawful intelligence, counterintelligence, and other national
security activities. We may disclose to correctional institution or law enforcement official
having lawful custody of protected health information of inmate or patient under certain
APPOINTMENT REMINDERS: We may use or disclose your health information to provide you
with appointment reminders (such as voicemail, email, text message and mail)
ACCESS: You have the right to look at or get copies of your health information, with limited
exceptions. You may request that we provide copies in a format other than photocopies. We
will use the format you request unless we cannot practicably do so. (You must make a request
in writing to obtain access to your health information. You may obtain a form to request access
by using the contact information listed at the end of this Notice. We will charge you a
reasonable cost-based fee for expenses such as copies and staff time. You may also request
access by sending us a letter to the address at the end of this Notice. If you request copies, we
will charge you a cost based fee for providing your health information. If you prefer, we will
prepare a summary or an explanation of your health information for a fee. Contact us using the
information listed at the end of the Notice for a full explanation of our fee structure.
DISCLOSURE ACCOUNTING: You have the right to receive a list of instances in which we or our
business associates disclosed your health information for purposes, other than treatment,
payment, healthcare operations and certain other activities for the time period that you have
been a patient in our office. If you request this accounting more than once in a 12 month
period, we will charge you a cost-based fee for responding to additional requests.
RESTRICTION: You have the right to request that we place additional restrictions on our use or
disclosure of your health information. We are not required to agree to these restrictions, but if
we do, we will abide by our agreement(except in an emergency.)
ALTERNATIVE COMMUNICATION: You have the right to request that we communicate with you
about your health information by alternative means or to alternative locations, (You must make
your request in writing.) Your request must specify the alternative means or location and
provide a satisfactory explanation how payments will be handled under the alternative means
or location you request.
AMENDMENT: You have the right to request that we amend your health information. (Your
request must be in writing, and it must explain why the information should be amended.) We
may deny your request under certain circumstances.
ELECTRONIC NOTICE: If you receive this Notice on our Website or by electronic mail ( email),
you are entitled to receive this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please
contact us. We support your right to the privacy of your health information.