Patient Privacy

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 Legal Duty to Protect Medical Information About You

We understand your medical information is personal and we are
committed to protecting your medical information. We comply
with legal requirement and provide you with the best quality of
care. This notice will describe how we may utilize and disclose
your medical information. This notice will also describe your
rights regarding our use and disclosure of such medical
information.

Our requirement by law is to ensure that identifiable medical
information concerning you is kept private, provide you with
this notice of our legal duties, your medical privacy and
disclosure. We reserve the right to change our privacy
practices and this notice at any time deemed necessary.

WE MAY DISCLOSE AND USE YOUR MEDICAL
INFORMATION WITHOUT YOUR WRITTEN
PERMISSION IN THE FOLLOWING CIRCUMSTANCES.

To provide medical treatment to you, and to coordinate or
manage your health care and related services. This may
include communicating with various health care specialists
regarding treatment and the management of your health care
with others. Example: Disclosing your medical information
concerning labs, prescriptions, or other healthcare services,
such as referrals to health care providers.

We may disclose and utilize your medical information to bill and
receive payment for services. Example: Forwarding a bill to
your insurance company.

The information located on the bill may include personal
identifying information, your diagnosis, supplies utilized, and
treatment. This is provided to receive payment for medical
services rendered. Expected treatment plans may be discussed
to obtain insurer prior approval to determine whether your
insurer will pay for medical treatment.

We will disclose medical information for hospital and clinical
operations which will ensure you are provided with appropriate
and quality patient care.

We will contact you concerning information concerning
treatment alternatives, specialist, health benefits for service, or
appointments.

We may disclose medical information to our business
associates to care out payment, health care objectives, or
treatment. Example: We utilize billing companies to process
our medical claims to bill your insurance company for services
rendered.

We will disclose medical information when required by local,
federal, or state law. This requirement may be required for
national security and intelligence objectives.

When necessary to prevent serious threat to your health and
safety or the health and safety of others.

Members of the Armed Forces information may be released to
their commands.

YOUR RIGHTS REGARDING MEDICAL INFORMATION
ABOUT YOU.

You have the right to review and obtain copies of medical
information used to make decisions concerning your medical
care. This will involve the use for medical, administrative,
and billing purposes, excluding psychiatric therapy notes related
to your care. You may inspect and copy your information with
a submission of request to the Medical Director or
Administrator of Tiomico-Trahan Family Care Center, P. A.

• If you request a copy, we may request a fee for costs
incurred from copying mailing, or other supplies associated
with this request. Under special limited circumstances, we
reserve the right to refuse forwarding, copying this medical
information.

Right to Amend your Information

If you think your medical information we have collected about
you is incomplete, or inaccurate, you may request correction or
the addition of information. You have the right to amend billing
and clinical information concerning your care. This request
must in writing and specified corrections should be detailed as
to reasons for the amendment.
Reasons for denial of your request:
• Information created by another provider.
• Information is believed to be correct and complete.
We will forward specific documentation, if a denial for your
request has been specified. If the request has been approved,
reasonable efforts will be made to inform others as to the
amendment.

Right to Accounting Disclosures

This is a list of the accounting of disclosure of medical
information concerning you, outside the above specified
disclosures authorized by you regarding billing, health
collections, care operations, medical and psychiatric treatment,
requests made by or that you authorized, permitted disclosures
made to specialists involved in your care, or other purposes
previously described.

In your request for the list of disclosures, please submit in
writing to the Administrator of Tiomico-Trahan Family Care
Center, P.A. You must submit the time period no greater than
six years and not prior to April 14, 2003.

Request for Restrictions

You have the right to request limitation or restriction to the
medical information we disclose about your treatment, health
care operations, or payment. We do not have to comply with
this request. If we do agree to comply, we will comply with
exception to the requirement to provide emergency treatment
for you, required by the Secretary of the Department of Health
and Human Services, and/or disclosures listed within this notice.

To request restrictions in writing:
• What information is to be limited.
• To whom you wish the limits to apply.

Changes to this notice

We reserve the right to change this notice at anytime. We
reserve the right to make the revised or changed notice for
medical information we already have about you, as well as,
information to be received in the future.





	We may disclose your health information as required by law for Public Health Services, which may assist in preventing and controlled disability, injury, or disease, reporting births, mediation allergies, drug interactions, neglect, abuse, or domestic violence. We may disclose your health information to an extent authorized by laws governing worker’s compensation or similar programs, which may provide worker’s benefits for related injuries or illnesses at the workplace. We may disclose your health information to agencies that enforce licensure or accreditation requirements, such as audits, inspections, or investigations. We may disclose your health information in response to a court or administrative order. This may in response to a subpoena, discovery, or lawful process, such as law enforcement. Example: We must comply will laws involve the reporting of specific wounds and physical injuries, i.e. dog bites, physical abuse. We may disclose your health information to medical examiners, funeral directors, or coroners consistent with applicable laws to carry out their responsibilities. We may disclose your health information to a correctional facility in which you may be in their custody, if required to maintain your health and safety. *SPECIAL CIRCUMSTANCES* Alcohol, Drug Abuse, and Psychiatric Treatment Information have special privacy protections under the law. We will not disclose any medial information relating to these issues unless: • Patient consents in writing. • Court order requires disclosure.