Your Information. Your Rights. Our Responsibilities.
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.
American Liver & Metabolic Center is committed to protecting the confidentiality of information about you and is required by law to do so. This notice describes how your information may be used and disclosed to others outside of ALMC. This notice also describes the rights you have concerning your own health information and how you can get access to your medical records.
You have the right to inspect and receive an electronic or paper copy of the protected health information (PHI) that we maintain about you in our designated record set for as long as we maintain that information. This includes your medical and billing records, as well as any other records we use for making decisions about you.
If you wish to inspect or copy your PHI, you must submit your request in writing to our Compliance Officer. We may charge you a reasonable, cost-based fee for fulfilling your request. Usually we will respond to your request within 30 days.
You have the right to request that we amend your PHI. You must make this request in writing to our compliance department. The request must state the reason for the amendment. We may deny your request if it is not in writing, does not state the reason for the amendment, or if the information is accurate and complete in our opinion.
You have the right to request how we communicate with you to preserve your privacy. For example, you can ask us not to call your home, but to communicate only by mail. You must submit your request in writing to our Compliance Officer. The request must specify how or where we are to contact you. We will accommodate all reasonable requests.
You have the right to request a restriction or limitation of how we use or disclose your PHI for treatment, payment, or health care operations. Although we are not required to agree to your requested restriction, if we do agree, we will comply with your request unless the information is needed for emergency treatment.
If you pay in full for a service or health care item out-of-pocket, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.
You can ask for a list (accounting) of the times we've shared (disclosed) your PHI for six years prior to the date you ask, who we shared it with, and why. We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You have the right to receive a paper copy of this notice upon request. You may obtain a copy by asking our receptionist at your next visit or by calling and asking us to mail you a copy.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI. We will make sure the person has this authority and can act for you before we take any action.
You have the right to file a complaint with our Compliance Officer or with the Secretary of the Department of Health and Human Services if you believe we have violated your privacy rights. Complaints to our office must be in writing.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
We may use your PHI and share it with other professionals who are treating you, such as doctors, physician assistants, nurses, therapists, emergency service and medical transportation providers, medical equipment providers, and others involved in your care.
Example: We will allow your physician to have access to your medical record to assist in your treatment and for follow-up care.
We may use and disclose your PHI to get paid for the medical services and supplies we provide to you. We may also disclose your PHI to another health care provider, health care clearinghouse or health plan for their payment activities.
Example: Your health plan or health insurance company may request to see parts of your medical record before they will pay us for your treatment.
We may use and disclose your PHI to support our business activities. We may disclose your PHI to another health care provider, health care clearinghouse, health plan or organized health care arrangement we participate in, for certain business activities.
Example: We may use your PHI to review and evaluate our treatment and services or to evaluate our staff's performance while caring for you.
We are allowed or required to share your PHI in other ways - usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions before we can share your PHI for these purposes.
Certain uses and disclosures of your PHI require us to obtain your prior written authorization, including: uses and disclosures of psychotherapy notes; uses and disclosures for marketing purposes; and disclosures of your PHI in exchange for remuneration. Otherwise, except as stated in this notice, we will not use or disclose your PHI without your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have used or disclosed your information in reliance on the authorization.
We reserve the right to change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be posted in a prominent location in our office and on our website. Upon request, we will provide you with a copy of the revised notice.
American Liver & Metabolic Center is required by law to give you this notice and to follow the terms of the notice that is currently in effect. If you have any questions about this notice, or have further questions about how we may use and disclose information about you, please contact our Compliance Department:
