Mountain Peaks Urology Notice of Privacy Practices:
Updated 02/03/2010
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
Our pledge to you:
We understand that medical information about you is personal and confidential. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by our facility or by a referring doctor or another source. We are required by law to: keep medical information about you private, give you this notice of our legal duties and privacy practices with respect to medical information about
you, and follow the terms of the most current notice.
Changes to this notice:
We may change our policies at any time. We will post any significant changes to our policies in our office. The effective date is on the policy.
You can receive a copy of our practices any time, just let us know you’d like a copy.
How we may use and disclose medical information about you:
Your rights:
In most cases, you have the right to review and obtain a copy of medical information that we use to make decisions about your care by submitting a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records by submitting a request in writing that provides your reason for requesting the amendment.
We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; if it is not part of the information that you would be permitted to review or copy; or if we determine that the record or amendment is inaccurate. You may appeal, in writing, a decision by us not to amend a record.
You may request in writing that we not use or disclose medical information about you for treatment, payment or healthcare operations or to
persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request, but we are not legally required to accept it. We will inform you of our decision on your request. All written requests must tell us (1) what information you want to limit; (2) whether you want to limit our use or disclosure; and (3) to whom you want the limits to apply.
Complaints:
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact the privacy officer for Mountain Peaks Urology, at (719) 275-2000 during regular business hours. You may send a written complaint to the U. S. Department of Health and Human Services Office of Civil Rights as well. Under no circumstances will you be penalized or retaliated against for filing a complaint.
Updated 02/03/2010
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
Our pledge to you:
We understand that medical information about you is personal and confidential. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by our facility or by a referring doctor or another source. We are required by law to: keep medical information about you private, give you this notice of our legal duties and privacy practices with respect to medical information about
you, and follow the terms of the most current notice.
Changes to this notice:
We may change our policies at any time. We will post any significant changes to our policies in our office. The effective date is on the policy.
You can receive a copy of our practices any time, just let us know you’d like a copy.
How we may use and disclose medical information about you:
- We may use and disclose medical information about you for treatment, to obtain payment, and to support our health care operations.
- We may disclose certain medical information about you to certain business partners, so that they may help us to do our jobs. These business partners are required by contract and by law to comply with the provisions of HIPAA and give you the same rights as we do.
- We may use or disclose medical information about you without your prior authorization for several other reasons.
- Subject to certain requirements, we may give our medical information about you for public health purposes, abuse or neglect reporting, health
oversight audits or inspections, research studies, funeral arrangements and organ donation, workers’ compensation purposes, and emergencies. - We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders.
- Other special situations where we may give our medical information about you include if you are a member of the military of a veteran, for national security and intelligence activities, protective services for the President and others.
- We may contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health related benefits or services that may be of interest to you.
- We may disclose information about you to a friend or family member who is involved in your medical care, to someone who helps pay for your care or to disaster relief authorities so that your family can be notified of your location and condition.
Your rights:
In most cases, you have the right to review and obtain a copy of medical information that we use to make decisions about your care by submitting a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records by submitting a request in writing that provides your reason for requesting the amendment.
We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; if it is not part of the information that you would be permitted to review or copy; or if we determine that the record or amendment is inaccurate. You may appeal, in writing, a decision by us not to amend a record.
You may request in writing that we not use or disclose medical information about you for treatment, payment or healthcare operations or to
persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request, but we are not legally required to accept it. We will inform you of our decision on your request. All written requests must tell us (1) what information you want to limit; (2) whether you want to limit our use or disclosure; and (3) to whom you want the limits to apply.
Complaints:
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact the privacy officer for Mountain Peaks Urology, at (719) 275-2000 during regular business hours. You may send a written complaint to the U. S. Department of Health and Human Services Office of Civil Rights as well. Under no circumstances will you be penalized or retaliated against for filing a complaint.