You have certain rights regarding PHI that we maintain about you. Right To Access Your PHI. You have the right to review or obtain copies of your PHI records, with some limited exceptions. Usually the records include referral information, delivery forms, billing, claims payment, and medical management records. Your access to records can include PHI maintained electronically even if not an electronic health record. Your request to review and/or obtain a copy of your PHI records must be made in writing. We may charge a fee for the costs of producing, copying, and mailing your requested information, but we will tell you the cost in advance. Right To Amend Your PHI. If you feel that PHI maintained by us is incorrect or incomplete, you may request that we amend the information. Your request must be made in writing and must include the reason you are seeking a change. We may deny your request if, for example, you ask us to amend information that was not created by us, or you ask to amend a record that is already accurate and complete. If we deny your request to amend, we will notify you in writing. You then have the right to submit to us a written statement of disagreement with our decision and we have the right to rebut that statement. Right to Notification of Breach or Accounting of Disclosures. You have the right to be notified following a breach of your unsecured PHI. This will not include our disclosures related to your treatment, our payment or health care operations, or disclosures made to you or with your authorization. It may also exclude certain other disclosures, such as for national security purposes. You will be notified of any unauthorized release or access to your PHI. Your request for an accounting of disclosures must be made in writing and must state a time period for which you want an accounting. This time period may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically We may charge for providing the accounting, but we will tell you the cost in advance. Right To Request Restrictions on the Use and Disclosure of Your PHI. You have the right to request that we restrict or limit how we use or disclose your PHI for services, payment, or health care operations. You may restrict disclosures of PHI if you have paid out-of-pocket in full for the health care item or service. Your request for a restriction must be made in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit how we use or disclose your information, or both; and (3) to whom you want the restrictions to apply. Right To Receive Confidential Communications. You have the right to request that we use a certain method to communicate with you or that we send information to a certain location. For example, you may ask that we contact you at work rather than at home. Your request to receive confidential communications must be made in writing. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have a right at any time to request a paper copy of this Notice. You may ask us to give you a copy of this notice at any time. Contact Information for Exercising Your Rights. You may exercise any of the rights described above by contacting our privacy Office. Complaints. If you believe that your privacy rights have been violated, you may file a complaint with us and/or with the Office of Civil Rights.
All complaints must be submitted in writing. You will not be penalized for filing a complaint. This Notice of Privacy Practices is effective as of December 20th, 2013