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HIPAA/Privacy Policy
We are committed to protecting the
confidentiality of your health information.
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.
We are required by law to maintain the privacy of
your medical information. We are also required to
notify you of our legal duties and privacy practices
regarding your medical information and abide by the
terms of this Notice, unless more stringent laws or
regulations apply.
This Notice applies to and describes this
facility/organization’s practices and those of:
- All health care professionals authorized to
enter information into your facility record;
- All members of the medical staff
credentialed to practice at this facility;
- All departments and units of this facility;
- All employees, staff and other facility
personnel;
- All volunteers, interns, or students we
allow to help you while you are a patient at
this facility;
This Notice of Privacy Practices provides
detailed information about how we may use and
disclose your medical information with or without
authorization as well as information about your
specific rights with respect to your medical
information. This Notice is effective August 18,
2008.

Disclosures of Your Medical Information for
Treatment, Payment, and Operations That We May Make
Without Authorization
Treatment
We may share your information with those who
provide you with health care services, those who
coordinate your care and in the process of making
referrals for your care. Examples of health care
providers who may need your information include your
doctor, pharmacist, nurse, physical therapist, home
health provider and imaging technician.
We may use your information to contact you for
appointments and to provide information about
health-related products and services that we believe
may be helpful to you.
We may share your medical information with a
family member or friend who assists with your care.
We will only do this if you agree, and share only
the information they need to help you. If you are
unable to agree or object to this, we may disclose
your health information if we determine that it is
in your best interest based on our professional
judgment.
We may disclose health information about you to
an entity assisting in a disaster relief effort so
that family and friends can be notified about your
condition, status and location.
Payment
We may use and give your medical information
to others to bill and collect payment for the
treatment and services provided to you. Your
insurance company or health plan may need your
information for activities such as determining your
eligibility for coverage, reviewing the medical
necessity of the health care services, or providing
approval for hospital stays.
Healthcare Operations
We may use and disclose your health information in
performing business activities, which we call
healthcare operations. These health care operations
allow us to improve the quality of care we provide
and reduce health care costs. Some of these
activities include quality assessment, employee
review, training of medical personnel, licensure and
accreditation, and audits by regulatory agencies.
Business Associates
We may share your protected health information with
third parties who perform services for us such as
transcription or billing. We have written agreements
with these third parties that they will not use or
disclose your information for any other purposes,
except as required by law.
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Other
Disclosures We May Make Without Your Authorization
There are reasons that your medical information
may be used without your authorization, generally
either because it is required by law or for public
health and safety purposes. These include:
Required by Law
Your medical information may be used or disclosed
when required by law. We will comply with the law
and only disclose the minimum information necessary.
Food and Drug
Administration We may disclose
your medical information as required by the Food and
Drug Administration to report adverse events,
product defects or problems, biologic product
deviations, or for product recalls, repairs or
replacements.
Public Health
Your medical information may be used for public
health activities. For example, we may disclose
health information about you if you have been
exposed to a communicable disease or may otherwise
be at risk of contracting or spreading a disease or
condition.
Abuse or Neglect
We may disclose your medical information as required
by law to report suspected child or elder abuse or
neglect. We may also disclose your health
information if an authorized government agency
believes that you have been a victim of abuse,
neglect or domestic violence. Disclosures of this
nature will be consistent with state and federal
law.
Health Oversight
Health oversight agencies are authorized to have
access to medical information maintained by us for
activities such as audits, investigations, and
inspections. This includes government agencies that
oversee the health care system, government benefit
programs, government regulatory programs, civil
right laws and all applicable accreditation
agencies.
Legal Proceedings and Law Enforcement
We may disclose your medical information for legal
proceedings and law enforcement purposes. Examples
of these purposes would be: (1) as required by an
administrative or legal proceeding or in response to
a subpoena or administrative order; (2) to identify
or locate a suspect, fugitive, material witness or
missing person; (3) information pertaining to crime
victims; (4) suspicion that death has occurred as a
result of criminal conduct; (5) crimes occurring on
the premises, and (6) medical emergencies where it
appears likely a crime has occurred.
Threat to Health and Safety
As required by state and federal laws, we may
disclose your medical information to a person or law
enforcement authority if we reasonably believe that
the use or disclosure is necessary to prevent or
lessen a serious and imminent threat to a person or
the public.
Research Your medical
information may be disclosed to researchers,
provided that the research has been approved by an
Institutional Review Board and the research
protocols have been approved to protect your
privacy.
Military Activity and National Security
Under certain circumstances, the medical information
of Armed Forces personnel may be disclosed; (1) for
activities deemed necessary by military command
authorities; (2) for the purpose of eligibility
determination by the Department of Veterans Affairs
for benefits; or (3) to a foreign military authority
if you are a member of that service. Your medical
information may be disclosed for conducting national
security and intelligence activities, including
protective services to the President of the United
States.
Workers’ Compensation Your
medical information may be used or disclosed as
necessary to comply with workers’ compensation laws
and other similar legally established programs.
Inmates Your medical
information may be used or disclosed by us if you
are an inmate of a correctional facility and the
information is necessary to provide continuing care.
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How We
May Use and Disclose Your Medical Information with
Authorization
Other uses and disclosures of your medical
information will be made only with your written
authorization. You may revoke the authorization, in
writing, at any time, except to the extent that we
have already taken an action based on the original
authorization.
Authorization Forms are available in our clinic.
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YOUR
RIGHTS The following describes your rights
with respect to the medical information that we
maintain for you.
Right to Request Restrictions
You have the right to ask us to place restrictions
on the way we use or disclose your medical
information for treatment, payment, or healthcare
operations. We are not required to agree to the
request. If we do agree, we will not violate the
requested restriction except as needed for emergency
treatment purposes. If we decide to end the
restriction, we will notify you as required by law.
Confidential Communications
We will accommodate reasonable requests to
communicate with you about your medical information
by different methods or at different locations. For
example, if you are covered on a health plan but are
not the subscriber, and would like your medical
information sent to a different address than the
subscriber, we may do that for you. You need to make
your request in writing to our Clinic.
Access to your Medical Information
You have the right to inspect and receive a
copy of the medical information that we maintain for
you, with some limited exceptions. If we deny you
access based on those exceptions, you will be
provided with a timely, written explanation. We
reserve the right to charge a reasonable fee for the
cost of producing and mailing the copies. For a copy
of our access policy and for information about the
associated costs, you may contact our Clinic.
Amendment of Your Medical Information
You have the right to ask us to make changes to your
medical information. The request must be made in
writing to our clinic. In certain situations we may
deny your request. The reason for denial will be in
writing. You have the right to appeal our denial by
filing a written statement of disagreement. For more
information about this process, contact our Clinic.
Listing of Disclosures You
have a right to a listing of the disclosures we make
of your medical information, except for those
disclosures made for treatment, payment, or
healthcare operations, or those disclosures made
based on your authorization. The type of disclosures
typically contained in a listing would be
disclosures made for mandatory public health
purposes, law enforcement, legal proceedings, or for
other required reporting such as birth and death
certificates. A request form is available at our
Clinic.
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Questions and Complaints
If you are concerned that any of your privacy
rights have been violated, please contact
our clinic.
You also have the right to complain to the
Secretary of Health and Human Services by contacting
the US Department of Health and Human Services, 200
Independence Ave. SW, Washington, DC 20201.
You will not be retaliated against for filing a
complaint.
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Changes to Privacy Practices and the Notice
Home Towne Family Medicine reserves the right to
change its privacy practices and its Notice of
Privacy Practices at any time. The new notice will
be effective for any medical information we create
or maintain as of the date of the change. You may
request a copy of our most current Notice from
our clinic.
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