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Notice of Privacy Practices
This notice describes how medical information about you may be used
and disclosed and how you may get access to this information. Please
read it carefully.
ENT & Facial Plastic Surgery, P.A. (Practice) is dedicated to protecting
your Medical Information (MI) or Protected Health Information (PHI). We
are required by law to abide by the terms of this Notice, making any
revision applicable to all of the PHI we maintain. If we revise the
terms of this Notice, we will post a revised notice at the Office and
will make paper copies of this Notice of Privacy Practices. Your PHI is
available for review upon request.
How your medical information will be used and disclosed:
We will use your protected health information (PHI) as part of rendering
patient care. For example, your PHI may be used by the health care
professional treating you, by the business office to process your
payment for the services rendered and by our staff reviewing the quality
and appropriateness of the care received.
We may also use and/or disclose your information in accordance with
federal/state laws for the following:
- Unless you object, we may disclose to family members other relatives
or close personal friends, the medical information directly relevant to
such person’s involvement with your care.
- Unless you object, we may use or disclose your MI to notify a family
member, or other person responsible for your care of our location and
your general condition, or death.
- We may contact you to provide appointment reminders or information
about treatment alternatives or other health-related benefits that may
be of interest to you.
- We may disclose medical information (MI) when required by the U.S.
Department of Health and Human Services as part of an investigation or
determination of the Practice's compliance with relative laws.
- We may use or disclose your MI for public health activities, including
the reporting of disease, injury, and the conduct of public health
surveillance. We may disclose your MI concerning abuse, neglect, or
violence in accordance with federal and state law.
- We may disclose your MI in the course of certain judicial or
administrative proceedings.
- We may disclose your medical information for law enforcement
purposes/other specialized governmental functions.
- We may disclose your medical information to a coroner, medical
examiner, or funeral director.
- If you are an organ donator, we may disclose your MI to an organ
donation and procurement organization.
- We may use or disclose your MI for certain research purposes.
- We may use or disclose your MI to prevent or lessen a serious threat
to health & safety of another or the public.
- We may disclose your MI as authorized by laws relating to Workers Comp
or other programs.
We will not use or disclose your medical information for any other
purpose without your written authorization. Once given, you can revoke
your authorization at any time. Your rights regarding your medical information
You have the following rights with respect to your medical information:
- The right to request restrictions on certain uses and disclosures of
your Medical Information (MI). We are not required to agree to your
requested restriction, but if we do, we will honor it.
- The right to receive communications from us in a confidential manner.
- The right to inspect and copy your medical information. The right is
subject to certain specific exceptions and you may be charged a
reasonable fee for any copies of your records.
- The right to request an amendment of your medical information. We may
deny your request for certain specific reasons, and if denied, we will
provide you with written explanation for the denial and information
regarding further rights you would have at that point.
- The right to receive an accounting of the disclosures of your medical
information in the six years prior to your request (following April 14,
2003), except for disclosure for treatment, payment, or practice
operational purposes, disclosures pursuant to an authorization and
certain other specific disclosure types.
- The right to request a paper copy of this Notice of Privacy Practices
for Protected Health Information.
- The right to complain to the Practice and/or to the U.S. Department of
Health and Human Services, if you believe that the Practice has violated
your privacy rights. To complain to the Practice, please call:
Sandy Day Mikell, Compliance Officer at (601)268-5131
If you choose to file a complaint, you will not be retaliated against in
any way.
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