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.
Inland Psychiatric Medical Group is required to protect the privacy of your medical/health information. We respect the privacy and confidentiality of your protected healthcare information. PHI (Protected Healthcare Information - your medical record) may be used and released by your physician or other medical practitioner and by our office staff and others outside of our office who are involved in your care and treatment:
You may at any time request a listing of our business associates and normal business activities, which may require the disclosure of your PHI.
We may disclose your PHI to other third parties, including physicians, specialists, laboratory technicians, and hospital personnel in order to provide, manage, and/or coordinate your health care and other related services.
Your PHI will be used as needed to obtain payment for your health care services which includes allowing your health insurance company to review your PHI for medical necessity.
We may use or disclose your protected healthcare information in order to:
We may use or release your PHI as required for law enforcement purposes. These law enforcement purposes include:
We may release your PHI to a public health authority as required by law for purposes of:
We may release PHI to a government health oversight agency which oversees the healthcare system, its government benefit and regulatory programs and/or civil right laws for activities authorized by law to:
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected healthcare information that is subject to law that prohibits access. In some circumstances, you may have a right to have this decision reviewed.
This means you may ask us not to use or disclose any part of your protected healthcare information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected healthcare information not be disclosed to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply.
If your physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected healthcare information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by putting a description of your restriction in writing to your physician.
We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.
This means you may request an amendment of protected healthcare information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact to determine if you have questions about amending your medical record.
This right applies to disclosures for purposes other than those described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Contact of your complaint. We will not retaliate against you for filing a complaint.
We may change the terms of our notice at any time.
The new notice will be effective for all protected healthcare information that we maintain at that time. You can get a copy of any revised Notice of Privacy Practices by accessing our website www.InlandPsych.com or by calling one of our offices and requesting that a revised copy be sent to you in the mail or by asking for one at the time of your next appointment.
This notice is effective as of December 29, 2010.