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. If you have any questions about this notice, please contact: Jennifer Muff, ARNP, at 480-563-0634.
This notice describes the privacy practices at our office.
We are required by law to:
* Maintain the privacy of protected health information
* Give you this notice of our legal duties and privacy practices regarding your health information
* Follow the terms of the notice currently in effect.
How we may use and disclose your health information: Described as follows are the ways we may use and disclose your health information. Except for the following purposes we will use and disclose your health information only with your written permission. You may revoke such permission at any time by writing to Moxi Medical Associates at the above address.
Treatment: We may use and disclose your health information for your treatment and to provide you with treatment-related health care services. For example, we may disclose your health information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
Payment: We may use and disclose your health information so that others or we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may give information to your lab of choice in order for your insurance may pay for it.
Health Care Operations: We may use and disclose, as needed, your health information in order to support the business activities and to evaluate and improve our medical care. These activities include, but are not limited to, quality assessment, employee review, training of medical students, licensing, fundraising, and conducting or arranging for other business activities. For example, we may use and disclose information to a peer review organization or a health plan that is evaluating our care. We may also share information with others that have a relationship with you for their health care operation activities. If we use or disclose your protected health information for fundraising activities, we will provide you the choice to opt out of those activities. You may also choose to opt back in. We will not use or disclose any of your protected health information that contains genetic information that will be used for underwriting purposes.
Appointment Reminders, Treatment Alternatives, and Health- Related: We may use and disclose your PHI to contact you to remind you that you have a scheduled medical appointment or to advise you of treatment options or alternatives or health related benefits and services which may be of interest to you. Although this office does not use encrypted text or email, we may disclose relevant medical information and limited treatment options via these media, as well as lab results and other private information.
Benefits and Services: We may use and disclose your health information to contact you and remind you of your appointment, to tell you about treatment alternatives or health-related benefits and services you could use.
• Individuals Involved in Your Care or Payment for Your Care: When appropriate, we may share limited health information with a person you have designated as involved in, or paying for, your care (such as your family or a close friend). We may notify your family about your location or condition or disclose such information to an entity assisting in disaster relief.
• Research: We may use and disclose your health information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another for the same condition. Before we do so, the project needs to go through a special approval process. Even without special approval, we may permit researchers to look at records to help identify patients who may be included in their research, as long as they do not remove or copy any of your health information.
• As Required by Law: We will disclose your health information when required to do so by international, federal, state or local law. However, we will make every attempt to contact you before releasing this information.
Marketing & any purposes which require the sale of your information: These disclosures require your written authorization.
To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when necessary to prevent a serious threat to the health and safety of you, another person, or the public. Disclosures will be made only to someone who can reasonably be believed to help prevent the threat.
Business Associates: We may disclose your health information to our business associates that perform functions on our behalf or provide us with services if necessary. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose the information for any other purpose than appears in their contract with us.
Military and Veterans: If you are a member of the armed forces, we may release your health information as required by military command authorities. If you are a member of a foreign military we may release your health information to the foreign military command authority.
Worker's Compensation: We may release your health information for worker's compensation or similar programs that provide benefits for work-related injuries or illness.
Public Health Risks: We may disclose your health information for public health activities to prevent or control disease, injury or disability. We are mandated reporters in reporting births or deaths, suspected child abuse or neglect (or elderly or disabled), medication reactions or product malfunctions or injuries, and product recall notifications. We may use your health information to notify someone who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. If we are concerned that a patient may have been a victim of abuse, neglect, or domestic violence we may ask your permission to make a disclosure to an appropriate government authority. We will make that disclosure only when you agree or when required or authorized to do so by law.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law. These may include audits, investigations, inspections,
and licensure. These activities are necessary to for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose your health information in response to a court or administrative order. We may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. We will do everything in our power to prevent the disclosure of information for purposes which might result in harm to you, and it is the policy of this facility to rarely release direct records for any purpose other than patient request, generally speaking for continuity of care.
Law Enforcement: We may release your health Information request by law enforcement official if 1) there is a court order, subpoena, warrant, summons or similar process; 2) if the request is limited to information needed to identify or locate a suspect, fugitive, material witness, or missing person; 3) the information Is about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain your agreement; 4) the information is about a death that may be the result of criminal conduct; 5) the information is relevant to criminal conduct on our premises; and 6) it is needed in an emergency to report a crime, the location of a crime or victims, or the identity, description, or location of the person who may have committed the crime.
Coroners, Medical Examiners, and Funeral Directors: We may release your health information to a coroner, medical examiner, or funeral director to identify a deceased person or cause of death, or other similar circumstance.
National Security and Intelligence Activities: We may disclose your health information to authorized federal officials for intelligence and other national security activities authorized by law.
Inmates or Individuals in Custody: If you are an inmate of a correctional institution or in custody we may disclose your information I) for the institution to provide you with health care, 2) to protect your health .and safety or that of others, and 3) for the safety and security of the institution.
Any other uses and Disclosures not recorded in this Notice will be made only with your written authorization. You may revoke the authorization at any time by submitting a written revocation and we will no longer disclose your PHI, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Right to Inspect and Copy: Under Federal Law, you have the right to inspect and copy your medical and billing records by written request to Moxi Medical Associates. Generally speaking, the provider is allotted up to 30 days for this request and may be asked to compensate the cost of reproducing these records.
Right to Amend: If you feel that the PHI we have is incorrect or in complete, you may ask us to amend the information. A request and the reason for the requested amendment must be made in writing to Moxi Medical Associates. In certain cases we may deny your request. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy.
Right to an Accounting Of Disclosures: You have the right to receive an accounting of all disclosures except for disclosures: pursuant to an authorization, for purposes of treatment, payment, healthcare operations; required by law, that occurred six years prior to the date of request. Your request must be made in writing to Moxi Medical Associates, and you must indicate in what form you want the list, for example on paper or electronically.
The right to an Electronic copy of Electronic Medical Records: You have the right to request to be given to you or have transmitted to another individual or entity, an electronic copy of your medical records, if they are maintained in an electronic format. We will make every effort to provide the electronic copy in the format you request however if it is not readily producible by us we will provide it in either our standard format or in hard copy form.
Right to Request Restrictions: You have the right to request restriction or limitation on your health information used for treatment, payment or health care operations. You may ask us not to use or disclose any part of your PHI and by law we must comply when the PHI pertains solely to a health care item or service which the healthcare provider involved has been paid out of pocket in full. You may request us to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request to Moxi Medical Associates. If we agree to restriction, we may only be in violation of that restriction for emergency treatment purposes. By law, you may not request that we restrict the disclosure of your PHI for treatment purposes.
The Right to Get Notice of a Breach: You have the right to be notified upon a breach of any of your unsecured PHI.
Right to Request Confidential Communication: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that we contact you by mail at specific address or call you on a specific telephone number. Your written request Moxi Medical Associates. We will accommodate reasonable requests.
CHANGES TO THIS NOTICE
We may change this notice and make it effective for medical information we already have about you as well as new information. The current notice will be posted and available at all times. You have a right to request a paper copy of the current notice at any visit or by written request to Moxi Medical Associates. Please, copy this page and keep for your records.
You may file a complaint with us or with the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. To file a complaint with us you must make it in writing to Moxi Medical Associates. There will be noretaliation against you for filing a complaint.
To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W. Washington, D.C. 20201. Call (202) 619-0257 (or toll free (877) 696-6775) or go to the website of the Office for Civil Rights, www.hhs.gdocr/hippa/, for more information. There will be no retaliation against you for filing a complaint.
If you have any questions in reference to this form, please ask to speak with Jennifer Muff in person or by phone at the information at the end of this Notice. You have the right to request a paper copy of this Notice at any time even if you have agreed to receive this Notice electronically. A copy of this Notice may also be found on our website.
Please sign below to acknowledge you have received or have been given the opportunity to receive a copy of our Notice of Privacy Practices.