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.
1. Uses and Disclosures: Low-T Center is permitted by law to disclose the minimum necessary personal health information of each patient to carry out treatment, payment and health care operations. Treatment disclosures may be made to physicians and other health care providers as necessary to proceed with the appropriate treatment and care of patients. Personal health information may be disclosed to the government or other third party payers (insurance) for the purpose of obtaining payment for services provided. Personal health information may be disclosed to carry out the daily operations such as scheduling and appointment reminders, quality reviews, audits, healthcare oversight responsibilities, accounting and legal services. Use and disclosure of protected health information will be according to law and what is permitted and may include public health activities. A list of other examples of disclosures can be obtained from the Chief Privacy Officer upon request by contacting him at email@example.com.
2. Required Authorizations: Low-T Center will not disclose any patient’s personal health information for any purpose aside from payment, treatment and health care operations, and what is required and permitted by law without patient’s authorized consent to such disclosure. Upon request for such authorization, the patient shall have the right to refuse and/or revoke any disclosure of patient’s personal health information. The national privacy law permits disclosing personal health information to a parent or guardian; however, this information is protected for family planning services of minors, and will not be disclosed without an authorization from the patient.
3. Privacy Compliance: In accordance with the privacy regulations under the Health Insurance Portability and Accountability Act (HIPAA), 45 CFR Parts 160 and 164 (the “Privacy Regulations”), Low-T Center has adopted privacy policies regarding the use and disclosure of patients’ personal health information. Low-T Center is committed to comply with the Privacy Regulations and all other laws and regulations regarding patients’ right to privacy.
4. Patient’s rights: Patient’s have the right to access their medical record, to request amendments, and an accounting of disclosures. Low-T Center may deny the request under certain circumstances, for example, if it is determined that the information is accurate and complete. Patients have the right to issue complaints regarding privacy rights, or if they believe a patient’s privacy rights have been violated. Complaints must be issued in writing and can be presented to Low-T Center or the Secretary of the Department of Health and Human Services. There will be no retaliation against you for filing a complaint.