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HEALTHNOW MEDICAL CENTER, INC.
NOTICE OF PRIVACY PRACTICES
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.
HealthNow Medical Center, Inc. is required, by law, to maintain the privacy
and confidentiality of your protected health information and to provide our
patients with notice of our legal duties and privacy practices with respect
to your protected health information.
Disclosure of Your Health Care Information
Treatment
We may disclose your health care information to other healthcare professionals
within our practice for the purpose of treatment, payment or healthcare
operations. (example)
"On occasion, it may be necessary to seek consultation regarding your
condition from other health care providers associated with HealthNow
Medical Center, Inc.."
"It is our policy to provide a substitute health care provider, authorized
by HealthNow Medical Center, Inc. to provide assessment and/or treatment
to our patients, without advanced notice, in the event of your primary
health care provider's absence due to vacation, sickness, or other
emergency situation."
Payment
We may disclose your health information to your insurance provider for
the purpose of payment or health care operations. (example)
"As a courtesy to our patients, we will submit an itemized billing statement
to your insurance carrier for the purpose of payment to HealthNow Medical
Center, Inc. for health care services rendered. If you pay for your health
care services personally, we will, as a courtesy, provide an itemized billing
to your insurance carrier for the purpose of reimbursement to you. The billing
statement contains medical information, including diagnosis, date of injury or
condition, and codes which describe the health care services received."
Workers' Compensation
We may disclose your health information as necessary to comply with State
Workers' Compensation Laws.
Emergencies
We may disclose your health information to notify or assist in notifying a
family member, or another person responsible for your care about your medical
condition or in the event of an emergency or of your death.
Public Health
As required by law, we may disclose your health information to public health
authorities for purposes related to: preventing or controlling disease,
injury or disability, reporting child abuse or neglect, reporting domestic
violence, reporting to the Food and Drug Administration problems with
products and reactions to medications, and reporting disease or infection
exposure.
Judicial and Administrative Proceedings.
We may disclose your health information in the course of any
administrative or judicial proceeding.
Law Enforcement.
We may disclose your health information to a law enforcement official
for purposes such as identifying or locating a suspect, fugitive,
material witness or missing person, complying with a court order
or subpoena, and other law enforcement purposes.
Deceased Persons.
We may disclose your health information to coroners or medical examiners.
Organ Donation.
We may disclose your health information to organizations involved
in procuring, banking, or transplanting organs and tissues.
Research.
We may disclose your health information to researchers conducting research
that has been approved by an Institutional Review Board.
Public Safety.
It may be necessary to disclose your health information to appropriate
persons in order to prevent or lessen a serious and imminent threat to
the health or safety of a particular person or to the general public.
Specialized Government Agencies.
We may disclose your health information for military, national security,
prisoner and government benefits purposes.
Marketing.
We may contact you for marketing purposes or fundraising purposes, as
described below: (example)
"As a courtesy to our patients, it is our policy to call your home on
the evening prior to your scheduled appointment to remind you of your
appointment time. If you are not at home, we leave a reminder message on
your answering machine or with the person answering the phone. No personal
health information will be disclosed during this recording or message
other than the date and time of your scheduled appointment along with a
request to call our office if you need to cancel or reschedule your
appointment."
"It is our practice to participate in charitable events to raise awareness,
food donations, gifts, money, etc. During these times, we may send you a
letter, post card, invitation or call your home to invite you to participate
in the charitable activity. We will provide you with information about the
type of activity, the dates and times, and request your participation in
such an event. It is not our policy to disclose any personal health
information about your condition for the purpose of HealthNow Medical
Center, Inc. sponsored fund-raising events."
Change of Ownership.
In the event that HealthNow Medical Center, Inc. is sold or merged with
another organization, your health information/record will become the property
of the new owner.
Your Health Information Rights
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You have the right to request restrictions on certain uses and disclosures
of your health information. Please be advised, however, that HealthNow
Medical Center, Inc. is not required to agree to the restriction that you requested.
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You have the right to have your health information received or communicated
through an alternative method or sent to an alternative location other than
the usual method of communication or delivery, upon your request.
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You have the right to inspect and copy your health information.
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You have a right to request that HealthNow Medical Center, Inc. amend your
protected health information. Please be advised, however, that HealthNow Medical
Center, Inc. is not required to agree to amend your protected health information.
If your request to amend your health information has been denied, you will be
provided with an explanation of our denial reason(s)and information about how
you can disagree with the denial.
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You have a right to receive an accounting of disclosures of your protected
health information made by HealthNow Medical Center, Inc..
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You have a right to a paper copy of this Notice of Privacy Practices at any
time upon request.
Changes to this Notice of Privacy Practices
HealthNow Medical Center, Inc. reserves the right to amend this Notice of Privacy
Practices at any time in the future, and will make the new provisions effective
for all information that it maintains. Until such amendment is made, HealthNow
Medical Center, Inc. is required by law to comply with this Notice.
HealthNow Medical Center, Inc. is required by law to maintain the privacy of your
health information and to provide you with notice of its legal duties and privacy
practices with respect to your health information. If you have questions about
any part of this notice or if you want more information about your privacy
rights, please contact: Richard Petersen by calling this office at 408-733-0400.
If Richard Petersen is not available, you may make an appointment for a personal
conference in person or by telephone within 2 working days.
Complaints
Complaints about your Privacy rights, or how HealthNow Medical Center, Inc. has
handled your health information should be directed to Richard Petersen by calling
this office at 408-733-0400. If Richard Petersen is not available, you may make
an appointment for a personal conference in person or by telephone within 2
working days.
If you are not satisfied with the manner in which this office handles your
complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
This notice is effective as of January 1, 2003
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