Notice of Privacy Practices

Your Rights​

 

You have the right to:

• Get a copy of your paper or electronic medical record
   

• Correct your paper or electronic medical record
   

• Request confidential communication
   

• Ask us to limit the information we share
   

• Get a list of those with whom we've shared your information
   

• Get a copy of this privacy notice
   

• Choose someone to act for you
   

• File a complaint if you believe your privacy rights have been violated
   

 

Your Choices

 

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
   

• Provide disaster relief
   

• Include you in a hospital directory
   

• Provide mental health care
   

• Market our services and sell your information
   

• Raise funds
   

 

Our Uses and Disclosures

 

We may use and share your information as we:

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• Treat you
   

• Run our organization
   

• Bill for your services
   

• Help with public health and safety issues
   

• Do research
   

• Comply with the law
   

• Respond to organ and tissue donation requests
   

• Work with a medical examiner or funeral director
   

• Address workers' compensation, law enforcement, and other government requests
   

• Respond to lawsuits and legal actions
   

 

Details About Your Rights

 

Get a copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We’ll usually provide it within 30 days. A reasonable, cost-based fee may apply.

 

Ask us to correct your medical record

You may request a correction to health information you believe is incorrect or incomplete. We may deny the request, but we will explain our decision in writing within 60 days.

 

Request confidential communications

You may ask us to contact you in specific ways (e.g., phone or mail to a different address). We will honor all reasonable requests.

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Limit what we use or share

You can request we not share certain information for treatment, payment, or operations. While we are not required to agree, we will comply when legally required—such as if you pay out-of-pocket in full and request that we not share details with your insurer.

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Get a list of those we’ve shared with

You may request a list (accounting) of disclosures we’ve made of your information over the past six years, excluding disclosures for treatment, payment, and operations.

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Get a copy of this notice

You may request a paper copy of this notice at any time.

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Choose someone to act for you

If you have designated a medical power of attorney or have a legal guardian, that person may act on your behalf.

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File a complaint

If you believe your privacy rights have been violated, you may contact us using the information below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you.

 

Your Choices in How We Share Information

 

You have both the right and the choice to tell us to:

• Share information with family, friends, or others involved in your care
   

• Share in disaster relief efforts
   

• Include your information in a hospital directory
   

If you are unable to express preferences (e.g., unconscious), we may share information if we believe it's in your best interest or to prevent a serious threat to health or safety.

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We will never share your information without written permission for:

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• Marketing purposes
   

• Sale of your information
   

• Most sharing of psychotherapy notes
   

We may contact you for fundraising efforts, but you can ask not to be contacted again.

 

More Ways We Use or Share Information

 

We are allowed or required to share your information in other ways—often to contribute to public good. Before sharing, we must meet certain legal conditions. Examples include:

• Public health and safety: Preventing disease, reporting adverse reactions or suspected abuse, addressing serious health threats
   

• Research: We may use/share your information for health research
   

• Legal compliance: Sharing information as required by law
   

• Organ donation: Working with organizations for donation and transplantation
   

• Coroners, medical examiners, or funeral directors
   

• Workers’ compensation, law enforcement, or other government functions
   

• Lawsuits and legal actions
   

Learn more at www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

 

Our Responsibilities

 

• We are legally required to protect your health information.
   

• We will notify you of any breach that may compromise your data.
   

• We will follow the practices outlined in this notice.
   

• We will not use/share your information beyond what is outlined here without written permission. You may revoke your permission at any time.
   

Learn more at www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

 

Changes to This Notice

 

We may change the terms of this notice. The revised version will apply to all your information and will be made available at our office and on our website.

 

Contact Information

 

Alexander Medical
2680 S Val Vista, Building 6, Suite 131
Gilbert, AZ 85295
Phone: (480) 757-9713
Website: www.alexandermedcenter.com/privacy