NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW IT
CAREFULLY.
State and Federal laws require us to
maintain the privacy of your health information and to inform you about our
privacy practices by providing you with this Notice. We must follow the privacy practices as described below. This Notice will take effect on (insert date) and will remain in effect until
it is amended or replaced by us.
It is our right to change our privacy
practices provided law permits the changes.
Before we make a significant change, this Notice will be amended to
reflect the changes and we will make the new Notice available upon request. We reserve the right to make any changes in
our privacy practices and the new terms of our Notice effective for all health
information maintained, created and/or received by us before the date changes
were made.
You may obtain a copy of our Privacy
Notice at any time by contacting our Privacy Officer or by printing this web
page. Information on contacting us can
be found at the end of this Notice.
TYPICAL USES AND DISCLOSURES OF
HEALTH INFORMATION
We will keep your health information confidential, using
it only for the following purposes:
Treatment:
We may use your health information to provide you with our professional
services. We have established “minimum
necessary or need to know” standards that limit various staff members’ access
to your health information according to their primary job functions. Everyone on our staff is required to sign a
confidentiality statement.
Disclosure:
We may disclose and/or share your healthcare information with other health
care professionals who provide treatment and/or service to you. These professionals will have a privacy and
confidentiality policy like this one.
Health information about you may also be disclosed to your family,
friends and/or other persons you choose to involve in your care, only if
you agree that we may do so.
Payment:
We may use and disclose your health information to seek payment for
services we provide to you. This
disclosure involves our business office staff and may include insurance organizations
or other businesses that may become involved in the process of mailing
statements and/or collecting unpaid balances.
Emergencies:
We may use or disclose your health information to notify, or assist in
the notification of a family member or anyone responsible for your care, in
case of any emergency involving your care, your location, your general
condition or death. If at all possible
we will provide you with an opportunity to object to this use or
disclosure. Under emergency conditions
or if you are incapacitated we will use our professional judgment to disclose
only that information directly relevant to your care. We will also use our professional judgment to make reasonable
inferences of your best interest by allowing someone to pick up filled
prescriptions, x-rays or other similar forms of health information and/or
supplies unless you have advised us otherwise.
Healthcare Operations: We will use and disclose your health information to keep our
practice operable. Examples of
personnel who may have access to this information include, but are not limited
to, our medical records staff, outside health or management reviewers and
individuals performing similar activities.
Required by Law:
We may use or disclose your health information when we are required to
do so by law. (Court or administrative
orders, subpoena, discovery request or other lawful process.) We will use and disclose your information
when requested by national security, intelligence and other State and Federal
officials and/or if you are an inmate or otherwise under the custody of law
enforcement.
Abuse or Neglect: We may disclose your health information to appropriate
authorities if we reasonably believe that you are a possible victim of abuse,
neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to
the extent necessary to prevent a serious threat to your health or safety or
that of others.
Public Health Responsibilities: We will disclose your health care information to report
problems with products, reactions to medications, product recalls,
disease/infection exposure and to prevent and control disease, injury and/or
disability.
Marketing Health-Related
Services: We will not use your health information
for marketing purposes unless we have your written authorization to do so.
National Security: The health information of Armed Forces
personnel may be disclosed to military authorities under certain
circumstances. If the information is
required for lawful intelligence, counterintelligence or other national
security activities, we may disclose it to authorized federal officials.
Appointment Reminders: We may use or disclose your health information to provide
you with appointment reminders, including, but not limited to, voicemail
messages, postcards or letters.
YOUR PRIVACY RIGHTS AS OUR PATIENT
Access: Upon
written request, you have the right to inspect and get copies of your health
information (and that of an individual for whom you are a legal guardian.) There will be some limited exceptions. If you wish to examine your health
information, you will need to complete and submit an appropriate request form. Contact our Privacy Officer for a copy of
the Request Form. You may also
request access by sending us a letter to the address at the end of this
Notice. Once approved, an appointment
can be made to review your records.
Copies, if requested, will be charged for each page depending on staff
time required and cost of materials. If you want copies mailed to you, postage will also be
charged. If you prefer a summary or an
explanation of your health information, we will provide it for a fee. Please contact our Privacy Officer for a fee
and/or for an explanation of our fee structure.
Amendment: You
have the right to amend your healthcare information, if you feel it is
inaccurate or incomplete. Your request
must be in writing and must include an explanation of why the information
should be amended. Under certain
circumstances, your request may be denied.
Non-routine Disclosures: You have the right to receive a list of non-routine
disclosures we have made of your health care information. (When we make a routine disclosure of your
information to a professional for treatment and/or payment purposes, we do not
keep a record of routine disclosures: therefore these are not available.) You have the right to a list of instances in
which we, or our business associates, disclosed information for reasons other
than treatment, payment or healthcare operations. You can request non-routine disclosures going back 6 years
starting on April 14, 2003. Information
prior to that date would not have to be released. (Example: If you request
information on May 15, 2004, the disclosure period would start on April 14,
2003 up to May 15, 2004. Disclosures
prior to April 14, 2003 do not have to be made available.)
Restrictions: You have the right
to request that we place additional restrictions on our use or disclosure of
your health information. We do not
have to agree to these additional restrictions, but if we do, we will abide by
our agreement. (Except in emergencies.) Please contact our Privacy Officer if you
want to further restrict access to your health care information. This request must be submitted in writing.
QUESTIONS AND COMPLAINTS
You have the right to file a complaint with us if you
feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your
privacy rights, or if you disagree with a decision we made regarding your
access to your health information, you can complain to us. In writing. Request a Complaint Form from our Privacy
Officer. We support your right to the
privacy of your information and will not retaliate in any way if you choose to
file a complaint with us or with the U.S. Department of Health and Human
Services.
HOW TO CONTACT US
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Practice Name: Creative Medical
Institute Ltd. |
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Privacy Officer: Ms. Christine Van Vleek |
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Telephone: 757-490-9311 |
Fax: 757-490-9266 |
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E-Mail: Chris@doctornash.com |
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Address: 5589 Greenwich Road, Suite 175 Virginia Beach, VA 23462 |
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