To our patients:
This notice describes how health information about you, as
a patient of this practice, may be used and disclosed, and
how you can get access to your health information. This is
required by the Privacy Regulations created as a result of
the Health Insurance Portability and Accountability Act of
1996 (HIPAA).
Our commitment to your privacy
Our practice is dedicated to maintaining the privacy of your
health information. We are required by law to maintain the
confidentiality of your health information. We realize that
these laws are complicated, but we must provide you with the
following important information:
The following circumstances may require us to use
or disclose your health information:
- To public health authorities and health oversight agencies
that are authorized by law to collect information.
- Lawsuits and similar proceedings in response to a court
or administrative order.
- If required to do so by a law enforcement official.
- When necessary to reduce or prevent a serious threat
to your health and safety or the health and safety of another
individual or the public. We will only make disclosures
to a person or organization able to help prevent the threat.
- If you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate
authorities.
- To federal officials for intelligence and national security
activities authorized by law.
- To correctional institutions or law enforcement officials
if you are an inmate or under the custody of a law enforcement
official.
- For Workers Compensation and similar programs.
Your rights regarding your health information
- Communications. You can request that our practice communicate
with you about your health and related issues in a particular
manner or at a certain location. For instance, you may ask
that we contact you at home, rather than work. We will accommodate
reasonable requests.
- You can request a restriction in our use or disclosure
of your health information for treatment, payment, or health
care operations. Additionally, you have the right to request
that we restrict our disclosure of your health information
to only certain individuals involved in your care or the
payment for your care, such as family members and friends.
We are not required to agree to your request; however, if
we do agree, we are bound by our agreement except when otherwise
required by law, in emergencies, or when the information
is necessary to treat you.
- You have the right to inspect and obtain a copy of the
health information that may be used to make decisions about
you, including patient medical records and billing records,
but not including psychotherapy notes. You must submit your
request in writing to Gary L. Gateley., Administrator. Mr.
Gateley may also be reached at 903.593.2468.
- You may ask us to amend your health information if you
believe it is incorrect or incomplete, and as long as the
information is kept by or for our practice. To request an
amendment, your request must be made in writing and submitted
to Gary L. Gateley, Administrator. Mr. Gateley may also
be reached at 903.593.2468. You must provide us with a reason
that supports your request for amendment.
- Right to a copy of this notice. You are entitled to receive
a copy of this Notice of Privacy Practices. You may ask
us to give you a copy of this Notice at any time. To obtain
a copy of this notice, you are free to download
this to your computer or contact Gary
L. Gateley, Administrator. Mr. Gateley may also be reached
at 903.593.2468.
- Right to file a complaint. If you believe your privacy
rights have been violated, you may file a complaint with
our practice or with the Secretary of the Department of
Health and Human Services. To file a complaint with our
practice, contact Gary L. Gateley., Administrator. Mr. Gateley
may also be reached at 903.593.2468.
- All complaints must be submitted in writing. You will
not be penalized for filing a complaint.
- Right to provide an authorization for other uses and
disclosures. Our practice will obtain your written authorization
for uses and disclosures that are not identified by this
notice or permitted by applicable law.
- If you have any questions regarding this notice or our
health information privacy policies, please contact Gary
L. Gateley, Administrator. Mr. Gateley may also be reached
at 903.593.2468.
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