Notice of Privacy Practices
New HIPAA standards require that patients be provided with advanced written notice of our practice's policies and procedures regarding the use and disclosure of protected health information. Health information is used for treatment, billing and payment, and health care operations.
Health information includes demographic and insurance policy information, past and present history, medications, allergies, current physical exam, X-rays and other diagnostic studies, and diagnostic impressions and treatment plans. Also this includes CPT procedure codes (see your encounter form) as well as diagnoses codes ( on encounter form).
Practices use appropriate procedure codes and diagnoses codes to substantiate and bill for services performed. If additional service or procedures are performed that do not have specific procedure codes then sometimes operative notes are submitted with the standard claim form.
Referring physicians and or regular physicians are usually sent a copy of each pertinent evaluation to keep them informed and aide them in coordination of care.
Our practice will on occasion perform investigative studies on our patients in order to improve patient care. Any data culled from our files will not be linked to a specific patient name. Even case reports which are somewhat more frequent will not be identified with the patients name.
Our consent includes the above mentioned three categories of need for disclosure of health information.
Authorization will be obtained for all other uses.
The patient can request restrictions on disclosure by filing a written request with our office.
The patient can inspect his medical records, copy them, and amend the records by filing a written request with our office.
The patient can request an accounting of disclosures of medical information by filing a written request with our office.
The patient can receive a paper copy of this Notice upon request.
If you believe your privacy rights have been violated then you can file a written request with this office and with HHS.
Our practice is required by law to safeguard this information.
Practice Employees with a job requirement to access PHI include the following
Amber Price treatment, billing and payment, health care operations
Terri Moseley treatment, billing and payment, health care operations
Cindy Shirey treatment, billing and payment, health care operations.
Office Staff signature ______________________ Date___________
Patient signature ______________________ Date___________