NOTICE OF PRIVACY PRACTICES - BRIEF VERSION
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.
Our commitment to your privacy
Our practice is dedicated to maintaining the privacy of your personal health
information as part of providing professional care. We also are required by
law to keep your information private. These laws are complicated, but we
must give you this important information. This pamphlet is a shorter version
of the full, legally required NPP which you received along with this so
refer to it for more information. However, we can't cover all possible
situations so please talk to our Privacy Officer (see the end of this
pamphlet) about any questions or problems.
We will use the information about your health which we get from you or from
others mainly to provide you with treatment, to arrange payment
for our services, and for some other business activities which are called,
in the law, health care operations. After you have read this NPP we
will ask you to sign a Consent Form to let us use and share your
information. If you do not consent and sign this form, we cannot treat you.
If we or you want to use or disclose (send, share, release) your information
for any other purposes we will discuss this with you and ask you to sign an
Authorization form to allow this.
Of course we will keep your health information private but there are some
times when the laws require us to use or share it. For example:
1. When there is a serious threat to your health and safety or the health
and safety of another individual or the public. We will only share
information with a person or organization who is able to help prevent or
reduce the threat.
2. Some lawsuits and legal or court proceedings.
3. For Workers Compensation and similar benefit programs.
There are some other situations like these but which don't happen very
often. They are described in the longer version of the NPP.
Your rights regarding your health information
1. You can ask us to communicate with you about your health and related
issues in a particular way or at a certain place which is more private for
you. For example, you can ask us to call you at home, and not at work to
schedule or cancel an appointment. We will try our best to do as you ask.
2. You have the right to ask us to limit what we tell people involved in
your care or the payment for your care, such as family members and friends.
While we don't have to agree to your request, if we do agree, we will keep
our agreement except if it is against the law, or in an emergency, or when
the information is necessary to treat you.
3. You have the right to look at the health information we have about you
such as your medical and billing records.* You can even get a copy of these
records but we may charge you. Contact our Privacy Officer to arrange how to
see your records. See below.
4. If you believe the information in your records is incorrect or missing
important information, you can ask us to make some kinds of changes (called
amending) to your health information. You have to make this request in
writing and send it to our Privacy Officer. You must tell us the reasons you
want to make the changes.
5. You have the right to a copy of this notice. If we change this NPP we
will post the new version in our waiting area and you can always get a copy
of the NPP from the Privacy Officer.
6. You have the right to file a complaint if you believe your privacy rights
have been violated. You can file a complaint with our Privacy Officer and
with the Secretary of the Department of Health and Human Services. All
complaints must be in writing. Filing a complaint will not change the health
care we provide to you in any way.
If you have any questions regarding this notice or our health information
privacy policies, please contact our Privacy Officer who is Beth Casenhiser
and can be reached by phone at (330) 644-3469 or by e-mail at bethadmin@akronfamilyinstitute.com
The effective date of this notice is April 14, 2003.
