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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.
We create medical records for each patient that receives
care from Sepehr Egrari, MD FACS. This office is dedicated
to protecting the privacy rights of our patients and the
confidentiality of the information we receive from our
patients. All of our employees and our business associates
are required to protect the confidentiality of your health
information. We may amend this Notice of Privacy Practices
from time to time. Should such amendments occur, we will
distribute our amended notice and will make the revised
notice otherwise available to
our patients.
Uses and Disclosures of Personal Healthcare
Information
We use and disclose the information we collect from you
only as allowed by law, and for the following types of
uses:
1. Treatment: We will use and disclose health information
in order to provide the highest level of quality care
and to ensure continuity of care between our office and
your other health care providers, as necessary and appropriate.
2. Payment: We will use and disclose health information
in order to collect payment for the services and treatment
we provide. It may be necessary to provide such information
to third parties such as insurance companies or other
third-party payors.
3. Health Care Operations: We may use health information
in order to manage the administrative aspects of our office.
This may include using health information in order to
measure the quality of our services or to provide education
to staff or other health care providers.
4. Personal Representatives/Family Members: We
may disclose health information to a patient’s personal
representative or family members unless the patient notifies
us that he or she objects to such disclosures. Such disclosures
will be limited to information relating to general condition.
5. Appointment Reminders/Treatment Alternatives:
We may use health information to provide appointment reminders
or information about treatment alternatives or other health-related
benefits and services that may be of interest to patients.
6. Other Uses: We may use and disclose health information
for other purposes upon obtaining a patient’s written
authorization for such uses and disclosures.
Patient Rights
Patients have the following rights with respect to protected
health information:
1. Right to Request Restrictions: Patients have
the right to request that we restrict uses or disclosures
of protected health information regarding the patient
to carry out treatment, payment, or health care operations,
or uses for which Patients have the opportunity to agree
or object. This office is not required to agree to a requested
restriction.
2. Right to Receive Confidential Communications of
Protected Health Information: Patients may request
that they receive communications of protected health information
from us by alternative means or at alternative locations.
We will accommodate all such reasonable requests submitted
by patients in writing. We may condition the provision
of a reasonable accommodation on, when appropriate, information
as to how payment, if any, will be handled.
3. Right to Inspect and Obtain a Copy of Protected
Health Information: Patients may request, in writing,
access to inspect or obtain a copy of their health care
information maintained by this office as medical or billing
records, or any other information that is used by this
office, in whole or in part, to make decisions about Patients.
Such requests may be denied in limited situations.
4. Right to Amend Protected Health Information:
Patients have the right to request, in writing, that we
amend their protected information maintained by this office
as medical or billing records, or any other information
that is used by this office, in whole or in part, to make
decisions about Patients. For all such requests, Patients
must provide a reason to support the request. Such requests
may be denied in limited situations.
5. Right to Receive Accounting of Disclosures of Protected
Health Information: Patients have the right to request
an accounting of disclosures of Protected Health Information.
We are not required to account for such disclosures in
limited situations. Otherwise, we will respond to all
such requests by providing an accounting of all disclosures
made in the six years prior to the request. We will provide
request forms as requested.
6. Notice of Privacy Practices: Patients, upon
request, have the right to obtain a paper copy of this
Notice of Privacy Practices, including patients who have
otherwise agreed to receive this Notice of Privacy Practices
in electronic form.
Our Duties
We have the following duties with respect to Patients'
Protected Health Information:
- Duty to Maintain Privacy: We are required by law to
maintain the privacy of Patients' Protected Health Information
and to provide Patients with this Notice of Privacy
Practices that describes our legal duties with respect
to Protected Health Information.
- Compliance with Terms of Notice: We are required to
abide by the terms of our Notice of Privacy Practices
currently in effect.
- Changes in Notice of Privacy Practices: We reserve
the right to amend this Notice of Privacy Practices
with respect to all Protected Health Information we
maintain. Should we amend this Notice of Privacy Practices,
we will provide Patients with the revised notice and
we will post and make the revised notice otherwise available
to Patients.
Complaints
Patients may complain to us and to the Secretary of
Health and Human Services if they believe their privacy
rights have been violated. Patients may file complaints
with this office by submitting the complaint in writing
to our office, Attention: Privacy Officer. We will not
retaliate against Patients submitting complaints pursuant
to this Notice of Privacy Practices.
Contact
For further information regarding this Notice of Privacy
Practices, or for any questions or concerns relating to
Protected Health Information, please contact our Privacy
Officer at
(425) 827-7878.
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