HIPAA Privacy Notice

 

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THIS NOTICE IS PROVIDED IN MY OFFICE AS REQUIRED BY LAW, UNDER HIPAA GUIDELINES. 

PLEASE REVIEW IT CAREFULLY. 

ABOUT THE NOTICE

This notice tells you about your privacy rights, my duty to protect health information that identifies you, and how I may use or disclose health information that identifies you without your written permission. This notice does not apply to health information that does not identify you or anyone else. 

In this Privacy Notice, “medical information” means the same as “health information.” Health information includes any information that relates to: 

1) Your past, present, or future physical or mental health or condition; 2) providing health care to you; or 3) the past, present, or future payment for your health care. 

YOUR PRIVACY RIGHTS The law gives you the right to: 

  • Look at or get a copy of the health information that I have about you, in most situations. I may require that your request be in writing.

  • Ask me to correct certain information; including certain health information, about you if you believe the information is wrong or incomplete. You must submit your request in writing to my office that has the information. If I deny your request to change the information, you can have your written disagreement placed in your record;

  • Ask for a list of the times I have disclosed health information about you for reasons other than treatment, payment, health care operations, and certain other reasons as provided by law, except when you have authorized or asked that I disclose the information. You must put this request in writing and must include the name of our office from which a list of disclosures is requested;

  • Ask me to limit the use or disclosure of information about you more than the law requires. However, the law does not require me to agree to limit uses and disclosures;

  • Tell me where and how to send you messages that include health information about you, if you think sending the information to your usual address could put you in danger. You must put this request in writing, and you must be specific about where and how to contact you;

  • Withdraw permission you have given me to use or disclose health information that identifies you, unless I have already taken action based on your permission. You must withdraw your permission in writing. You may exercise any of the rights described above by contacting me.

You may exercise any of the rights described above by contacting me. 

Marni Chanoff, MD