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Dr. Amy Chen - Acupuncture &
Chinese Herb Clinic - HIPAA Privacy Notice
The information provided below
illustrates the manner your protected health information could be
accessed and released and what you need to know about this process.
This important document should be reviewed thoroughly. Managing the
privacy of your protected health information is extremely important
to Dr. Amy Chen.
Legal Responsibilities of Dr. Amy
Chen: As mandated by Federal and State legal requirements, your
protected health information must be protected. As part of these
regulations, we are required to ensure you are aware of privacy
policies, legal duties, and your rights to your protected health
information. This notice of privacy policies, outlined below, will
be in effect for the duration and must be followed by our practice.
This notice will be in effect until it is replaced.
We reserve the right to modify our
privacy policies and the terms of this notice at any time, and will
make such modifications within the guidelines of the law. We reserve
the right to make the modifications effective for all protected
health information that we maintain, including protected health
information we created or received before the changes were made.
Changing the notice will precede all significant modifications. A
copy of this notice will be provided upon request.
Protected Health Information Use and
Disclosure: Information
regarding your health may be used and disclosed for the purpose of
treatment, payment, and other healthcare operations. Examples cited
below further explain the use and disclosure process.
Treatment:
Use and disclosure of your protected health information may be
provided to a physician or other healthcare provided providing
treatment to you. However, this information will not be provided
unless you have authorized it in writing.
Payment:
Your protected health information may be used and disclosed to
obtain payment for services we provided to you.
Healthcare Processes:
We may use and disclose your protected healthcare information in
relations with our healthcare process. These processes include an
assessment, improvement activities, reviewing the competence or
qualifications of healthcare professionals, provider performances
and evaluating practitioner, conducting training programs,
accreditation, certification, licensing, or credentialing
activities.
Your Authorization:
At any time, you may provide in writing your authorization for use
and disclosure of your protected health information for any purpose.
You may choose to revoke your written permission at any time. The
revocation must be in writing. If you revoke your written
authorization, it will not affect any use or disclosure prior to the
revocation.
Your protected healthcare
information may be use and disclosed to you, as described in the
patient rights section of this notice. In addition, your protected
health information may be used and disclosed to a family member,
friend, or other person to the extent necessary to assist you with
your healthcare, but only with your authorization.
Person Involved In Care:
In order to accommodate the notification of your location, your
general condition, or death, your protected health information maybe
used or disclosed to a family member, your personal representative,
or another person responsible for your care. If you are present and
wish to object to such disclosures of your protected health
information, you may do so. To the extent you are incapacitated or
emergency circumstances exist, we will disclose protected health
information using our professional judgment disclosing only
protected health information that is directly relevant to the
person’s involvement in your healthcare. We will use our
professional judgment and our experience with common practices to
make reasonable inferences of your best interest in allowing a
person to pick up filled prescriptions, medical supplies, x-rays, or
other similar forms of protected health information.
Marketing Health-Related Services:
The use of your protected health information for the purpose of
marketing communications is prohibited without your written
authorization.
Required By Law:
Your protected health information may be used or disclosed if
required by law.
Abuse or Neglect:
As required by law, if we have reason to believe that you are the
victim of possible abuse, neglect, domestic violence, or other
possible crimes, your protected health information may be disclosed
to the appropriate authorities. If we have reason to believe the use
or disclosure of your protected health information will prevent a
serious threat to your health or safety or the health or safety of
others we may have to provide the necessary protected health
information.
National Security:
Under some circumstances, the military may require disclosure of
healthcare information for armed forces personnel. For the purpose
of national security activities, counter intelligence and lawful
intelligence, authorized federal authorities may require disclosure
of protected health information. Protected healthcare information
disclosure may be made to correctional facilities or law enforcement
authorities with the lawful authority requiring custody of such
information.
Appointment Reminders:
Your protected healthcare information may be used to assist you with
appointment reminders in the form of voicemail messages, postcards,
or letters. We may also write a thank you card to whomever referred
you to our practice.
Patient Rights
Access: At all times, you
have the right to review your protected health information, with
limited exceptions. At your request, we will provide your
information in a format other than photocopies. If we are able to do
so, we will accommodate your request.
Your request to obtain access to
your information must be in writing. You may obtain a Protected
Health Information Access Form by using the contact information at
the end of this notice. We may need to charge you a reasonable
cost-based fee for expenses including copies and staff time. You may
also request access for submitting a letter using the information at
the bottom of this notice. If you request copies, we will charge you
$0.83 per page for the first 30 pages and $0.63 for every page after
that plus $19.00 for staff time to locate and copy you protected
health information. Postage will be included if you wish to have
your information mailed. If you request a different format, we will
charge a cost based fee for that format. An explanation of fees can
be made available.
Disclosure Accounting:
Your rights include the choice to receive a review of every time we
or our business associated disclosed your protected health
information for reasons other than treatment, payment, healthcare
information and certain other activities for the last six years.
Additional reasonable cost based fees may be extended if your
requests for such information are more than one time per year.
Restrictions:
You may request we apply additional restrictions to any disclosure
of your healthcare information. We are not required to respond to
the application of these additional restrictions. If we agree to
follow your request regarding additional restrictions, we will
follow the agreed restrictions unless an emergency situation
dictates otherwise.
Alternative Communication:
Your rights include the instruction to request how you are
communicated to regarding your protected health information. Your
request must be in writing and can spell out other ways or other
locations regarding your protected health information communication.
You must identify agreed upon explanations of payment arrangements
under alternative communications.
Amendment:
You can initiate a written request to amend your protected health
information. Included in the amendment must be an explanation why
information should be amended. Certain conditions may exist where we
may reject your request.
Electronic Notice:
If you receive a notice electronically, you are entitled to receive
the notice in writing as well.
Questions and Complaints
If at any time you are unsure or
concerned that your protected health information has not been
protected or if you believe an error was made in the decision we
made about accessing your protected health information; or in the
response to a request you made to amend the use or disclosure of
your protected health information; or to have us communicate to you
by an alternative means or at an alternative location, you have the
right to bring this issue forward. You may make a complaint to the
U.S. Department of Health and Human Services. We will provide you
with the address to file your complaint with the U.S. Department of
Health and Human Services at your request.
Privacy of your protected health
information remains extremely important; we are committed to ensure
your privacy. If you file a concern with the U.S. Department of
Health and Human Resources, we will not retaliate in any way. We are
available to assist you with any questions, concerns, or
complaints.
Contact
Person’s Name: Office Manager
Telephone:
425-456-8880
Address: 15710 NE 24th St Suite E
City, State,
Zip: Bellevue, WA 98008
Our HIPAA Privacy Policies are
also available for download in:
Microsoft Word Document
Adobe PDF format
Contact us at:
info@DrAmyChen.com
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