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NOTICE OF PRIVACY PRACTICES
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.
The Health Insurance Portability & Accountability Act of 1996
(HIPAA) requires all health care records and other individually
identifiable health information (protected health information)
used or disclosed to us in any form, whether electronically,
on paper, or orally, be kept confidential. This federal law
gives you, the patient, significant new rights to understand
and control how your health information is used. HIPAA provides
penalties for covered entities that misuse personal health
information. As required by HIPAA, we have prepared this explanation
of how we are required to maintain the privacy of your health
information and how we may use and disclose your health information.
Without specific written authorization, we are permitted to
use and disclose your health care records for the purposes
of treatment, payment and health care operations.
• Treatment means providing, coordinating, or managing health
care and related services by one or more health care providers.
Examples of treatment would include crowns, fillings, teeth
cleaning services, etc.
• Payment means such activities as obtaining reimbursement
for services, confirming coverage, billing or collection activities,
and utilization review. An example of this would be billing
your dental plan for your dental services.
• Health Care Operations include the business aspects of running
our company, such as conducting quality assessment and improvement
activities, auditing functions, cost-management analysis,
and customer service. An example would include a periodic
assessment of our documentation protocols, etc.
In addition, your confidential information may be used to
remind you of an appointment (by phone or mail) or provide
you with information about treatment options or other health-related
services including release of information to friends and family
members that are directly involved in your care or who assist
in taking care of you. We will use and disclose your PROTECTED
HEALTH INFORMATION when we are required to do so by federal,
state or local law. We may disclose your PROTECTED HEALTH
INFORMATION to public health authorities that are authorized
by law to collect information, to a health oversight agency
for activities authorized by law included but not limited
to: response to a court or administrative order, if you are
involved in a lawsuit or similar proceeding, response to a
discovery request, subpoena, or other lawful process by another
party involved in the dispute, but only if we have made an
effort to inform you of the request or to obtain an order
protecting the information the party has requested. We will
release your PROTECTED HEALTH INFORMATION if requested by
a law enforcement official for any circumstance required by
law. We may release your PROTECTED HEALTH INFORMATION to a
medical examiner or coroner to identify a deceased individual
or to identify the cause of death. If necessary, we also may
release information in order for funeral directors to perform
their jobs. We may release PROTECTED HEALTH INFORMATION to
organizations that handle organ, eye or tissue procurement
or transplantation, including organ donation banks, as necessary
to facilitate organ or tissue donation and transplantation
if you are an organ donor. We may use and disclose your PROTECTED
HEALTH INFORMATION 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. Under these circumstances,
we will only make disclosures to a person or organization
able to help prevent the threat. We may disclose your PROTECTED
HEALTH INFORMATION if you are a member of U.S. or foreign
military forces (including veterans) and if required by the
appropriate authorities. We may disclose your PROTECTED HEALTH
INFORMATION to federal officials for intelligence and national
security activities authorized by law. We may disclose PROTECTED
HEALTH INFORMATION to federal officials in order to protect
the President, other officials or foreign heads of state,
or to conduct investigations. We may disclose your PROTECTED
HEALTH INFORMATION to correctional institutions or law enforcement
officials if you are an inmate or under the custody of a law
enforcement official. Disclosure for these purposes would
be necessary: (a) for the institution to provide health care
services to you, (b) for the safety and security of the institution,
and/or (c) to protect your health and safety or the health
and safety of other individuals or the public. We may release
your PROTECTED HEALTH INFORMATION for workers' compensation
and similar programs.
Any other uses and disclosures will be made only with your
written authorization. You may revoke such authorization in
writing and we are required to honor and abide by that written
request, except to the extent that we have already taken actions
relying on your authorization.
You have certain rights in regards to your PROTECTED HEALTH
INFORMATION, which you can exercise by presenting a written
request to our Privacy Officer at the company address listed
below:
• The right to request restrictions on certain uses and disclosures
of PROTECTED HEALTH INFORMATION, including those related to
disclosures to family members, other relatives, close personal
friends, or any other person identified by you. We are, however,
not required to agree to a requested restriction. If we do
agree to a restriction, we must abide by it unless you agree
in writing to remove it.
• The right to request to receive confidential communications
of PROTECTED HEALTH INFORMATION from us by alternative means
or at alternative locations.
• The right to access, inspect and copy your PROTECTED HEALTH
INFORMATION.
• The right to request an amendment to your PROTECTED HEALTH
INFORMATION.
• The right to receive an accounting of disclosures of PROTECTED
HEALTH INFORMATION outside of treatment, payment and health
care operations.
• The right to obtain a paper copy of this notice from us
upon request.
We are required by law to maintain the privacy of your PROTECTED
HEALTH INFORMATION and to provide you with notice of our legal
duties and privacy practices with respect to PROTECTED HEALTH
INFORMATION.
We are required to abide by the terms of the Notice of Privacy
Practices currently in effect. We reserve the right to change
the terms of our Notice of Privacy Practices and to make the
new notice provisions effective for all PROTECTED HEALTH INFORMATION
that we maintain. Revisions to our Notice of Privacy Practices
will be posted on the effective date and you may request a
written copy of the Revised Notice from this office.
You have the right to file a formal, written complaint with
us at the address below, or with the Department of Health
& Human Services, Office of Civil Rights, in the event you
feel your privacy rights have been violated. We will not retaliate
against you for filing a complaint.
For more information about our Privacy Practices, please contact:
Privacy Officer
info@provideredge.com
Provider Edge, LLC.
6718 E. 123rd Place
Brighton, CO 80602
303-423-0334
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)
OR
The U.S. Department of Health & Human Services
Office for Civil Rights
1961 Stout Street, Room 1185 FOB
Denver CO 80294-3538
303-844-2024 Phone
303-844-2025 Fax
303-844-3439 TDD
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