Medical Data Privacy Policy

NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATIONNOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION.

Our Facility is dedicated to protecting your Medical Information (MI) or Protected Health Information
(PHI). We are required by law to maintain the privacy of PHI and to provide you with this notice of our
legal duties and privacy practices with respect to PHI. We are required by law to abide by the terms of
this Notice, making any revision applicable to all PHI we maintain. If we revise the terms of this Notice,
we will post a revised notice at the Office and will make paper copies of this Notice of Privacy Practices.
Your PHI is available for review upon request.

HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:

We will use your protected health information (PHI) as part of rendering patient care. For example, your
PHI may be used by the health care professional treating you, by the business office to process your
payment for the services rendered and by our staff reviewing the quality and appropriateness of the care
received.

We may also use and/or disclose your information in accordance with federal/state laws for the following:

Unless you object, we may disclose to family members other relatives or close personal friends, the medical information directly relevant to such person’s involvement with your care.

Unless you object, we may use or disclose your MI to notify a family member, or other person responsible for your care of our location and your general condition, or death.

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits that may be of interest to you.

We may disclose medical information (MI) when required by the U.S. Department of Health and Human Services as part of an investigation or determination of the Facility’s compliance with
relevant laws.

We may use or disclose your MI for public health activities, including the reporting of disease, injury, and the conduct of public health surveillance. We may disclose your MI concerning abuse, neglect, or violence in accordance with federal and state law.

We may disclose your MI in the course of certain judicial or administrative proceedings.

We may disclose your medical information for law enforcement purposes/other specialized governmental functions.

We may disclose your medical information to a coroner, medical examiner, or funeral director.

If you are an organ donator, we may disclose your MI to an organ donation and procurement organization.

We may use or disclose your medical information for certain research purposes.

We may use or disclose your MI to prevent or lessen a serious threat to health & safety of another or the public.

We may disclose your MI as authorized by laws relating to Workers Comp or other programs.

We will not use or disclose your medical information for any other purpose without your written
authorization. Once given, you can revoke your authorization at any time.