NOTICE OF PRIVACY PRACTICES EFFECTIVE APRIL 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
Federal and state law provides you with certain basic rights and protections in connection with the medical information we maintain about you. This notice summarizes your rights and LeGrand Associates duties with respect to your medical information. It is also designed to tell you how we may use or disclose your medical information and describes the complaint process for you to follow if you believe your privacy rights have been violated.
Your Rights With Respect To Your Medical Information
- Right to Inspect and Copy: You have the right to inspect and copy medical information about you; you submit your request must be in writing to LeGrand Associates' Privacy Officer. We may deny all or part of your request in certain very limited circumstances. You may under certain circumstances request that denial be reviewed.
- Right to Amend: You have the right to request an amendment for as long as the information is kept by or for us. If you feel any of the medical information about you is Incorrect or Incomplete, you may request us to amend such information. Amendment request must be made in writing and submitted to LeGrand Associates' Privacy Officer, and provide reason that supports your request. We may deny your request, if it is not in writing and no supporting reason In addition, your request may be denied if information:
- Was not created by us
- Is not part of the medical information kept by or for LeGrand Associates
- Is not part of the information which you would be permitted to Inspect or copy
- Is accurate and correct
USE AND DISCLOUSURE OF YOUR MEDICAL RECORDS
Uses and Disclosures of Medical Information That Do Not Require Your Authorization
a. We may use or disclose your Medical Information for the purpose of treatment, billing to receive payment, or healthcare operations without obtaining prior authorization.
b. As required by law, in response to subpoenas or judicial and administrative proceedings, for workers compensation, and appointment reminders without obtaining prior authorization.
c. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to Investigate or determine our compliance with the requirements of the HIPPA laws and regulations.
Uses and Disclosures of Medical Information That Require Your Authorization
a. Other uses and disclosures of your medical Information not covered by the preceding Categories will be made only with your written consent.
Changes to This Notice
a. We are required by the terms of this notice which are currently in effect. We reserve the right to amend this notice at any time and to apply amendments to your medical records that we have on file and any future information received. We will display a copy of the current notice in our office, and will upon request, provide you with a copy.
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filling a complaint.
Department of Health & Human Services
200 Independence Avenue, SW
Washington, DC 20201
(877) 696-6775 (Toll Free)
1601 Walnut Street
Philadelphia, PA 19102
(215) 496-1693 (Fax)