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
Notice of Health Information Practices
At Diabetes Wellness Clinic of America (DWCoA), we are committed to treating and using protected health information about you responsibly. This notice of Health Information Practices describes the personal information we collect, and how we disclose the information. It also describes your rights as they relate to your protected health information. This notice is effective August 1, 2009, and applies to all protected health information as defined by federal regulations.
Understanding your Health Record/Information
When you visit DWCoA, a record of your visit is made. This record contains your symptoms (if any), examination, test results, diagnoses and treatment (if appropriate), and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
Your Health Information Rights
Although your health record is the physical property of DWCoA, the information belongs to you. You have the right to:
- Obtain a paper copy of this notice of information practices upon your request,
- Inspect and copy your health record as provided for in 4 CFR 164.524, (You will of course, as part of our program, receive ALL test results, along with our physician’sevaluation of your health condition),
- Amend your health record as provided in 45 CFR 164.528,
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528,
- Request communications of your health information by alternative means or at alternative locations,
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
- Revoke your authorization to use or disclose information except to the extent that action has already been taken
American Diabetes Advocates is required to:
- Maintain the privacy of your health information,
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintainabout you,
- Abide by the terms of this notice,
- Notify you if we are unable to agree to a requested restriction, and
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We reserve the right to change our policies and practices concerning the privacy of your medical information we already have about you as well as any information we receive in the future.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received written revocation of authorization according to the procedures included in the authorization.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact the Practice Privacy Officer (716) 499-5622. All complaints must be submitted in writing.
If you believe we have violated your privacy rights, you can file a complaint with the Practice Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Room 509F, HHH Building, Washington, D.C. 20201.
Examples of Disclosures for Treatment and Health Operations
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of recommended treatment.
We will also provide your personal physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you have completed our program.
We will use your information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care you received. This information will then be used in an effort to continually improve the quality and effectiveness of the service we provide.
Business Associates: There are some services provided in our organization through contacts with Business Associates. Examples include diagnostic services and laboratory tests. When these services are contacted, we may disclose your health information to our Business Associates so that it can perform the job we’ve asked it to do.
To protect your health information, however, we require the business associate to appropriately safeguard your information.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.