The following paragraphs describe different ways that I may use and disclose your protected health information.  I have provided an example for each category, but these examples are not meant to be exhaustive.  All of the ways I am permitted to use and disclose your health information fall within one of these categories.

Treatment. I will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  I will also disclose your health information to other health care providers who may be treating you.  Additionally I may from time to time disclose your health information to another physician whom I have requested to be involved in your care.  For example--I would disclose your health information to a specialist to whom I have referred you for a diagnosis to help in your treatment.

Payment.  I will use and disclose your protected health information to obtain payment for the health care services I provide you.  For example--I may include information with a bill to a third-party payer that identifies you, your diagnosis, procedures performed, and supplies used in rendering the service.

Health Care Operations.  I will use and disclose your protected health information to support the business activities of our practice. For example--I may use medical information about you to review and evaluate our treatment and services or to evaluate our performance while caring for you.

Other Ways I May Use and Disclose Your Protected Health Information:

Appointment Reminders:  I will use and disclose your protected health information to contact you as a reminder about scheduled appointments or treatment.

Treatment Alternatives:  I will use and disclose your protected health information to tell you about or recommend possible alternative treatments or options that may be of interest to you.

Others Involved in Your Care:  I will use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identify that is involved in your medical care or payment for care.

Research:  I will use and disclose your protected health information to researchers, provided the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

As Required by Law:  I will use and disclose your protected health information when required to by federal, state, or local law.

To Avert a Serious Threat to Public Health or Safety:  I will use and disclose your protected health information to public health authorities permitted to collect or receive the information for the purpose of controlling disease injury, or disability.  If directed by that health authority, I will also disclose your health information to a foreign government agency that is collaborating with the public health authority.

Your Health Information Rights

Although your health record is the physical property of the practitioner or facility that compiled it, the information belongs to you. You have a right to:

A Paper Copy of This Notice: You have the right to receive a copy of this notice upon request. You may obtain a copy by mail, or per your written request.

Inspect and Copy: You have the right to inspect and copy the protected health information that I maintain about you in our designated record set for as long as I maintain that information. This designated record set includes your medical and billing records, as well as any other records I use for making decisions about you. Any psychotherapy notes that may have been included in records I received about you are not available for your inspection or copying, by law. I may charge you a fee for the costs of copying, mailing, or other supplies used in fulfilling your request.

Request Amendment: You have the right to request that I amend your medical information if you feel that it is incomplete or inaccurate. You must make this request in writing to our office, stating exactly what information is incomplete or inaccurate and the reasoning that supports your request.

 I am permitted to deny your request if it is not in writing or does not include a reason to support the request. I may also deny your request if:

• The information is not part of the designated record set kept by this practice or if it is the  opinion of the health care provider that the information is not accurate and complete.

•  The information was not created by us, or the person who created it is no longer available to make the amendment.

• The information is not part of the record which you are permitted to inspect and copy.  

I am not required to agree to your request if I feel it is in your best interest to use or disclose that information. If I do agree, I will comply with your request except for emergency treatment.

Request Restrictions:You have the right to request a restriction of how I use or disclose your medical information for treatment, payment, or health care operations. For example--you could request that I not disclose information about a prior treatment to a family member or friend who may be involved in your care or payment for care.

Request Confidential Communications: You have the right to request how I communicate with you to preserve your privacy. For example--you may request that I call you only at your work number, or by mail at a special address or postal box. Your request must be made in writing and must specify how or where I am to contact you. I will accommodate all reasonable requests.

If you believe your privacy rights have been violated, you may make a complaint to our office manager by calling 828.391.8757, or in writing to the office address. You may also make a complaint to the Secretary of Health and Human Services at the address listed below. If you make a complaint to the Secretary of Health and Human Services, it must be in writing and contain the name of the provider or office, describe the act or omission believed to be in violation and must be filed within 180 days of the incident. You will not suffer any retaliation for filing a complaint.

Secretary of Health & Human Services 200 Independence Avenue SW Washington, DC 20201