English 
Español NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please see the receptionist to request a copy.
Understanding Your Health Record/Information
Each time you visit a hospital, physician or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:- Basis for planning your care and treatment.
- Means of communication among the many health professionals who contribute to your care.
- Legal document describing the care you received.
- Means by which you or a third-party payer can verify that services billed were actually provided.
- Tool in educating health professionals.
- Source of data for medical research.
- Source of information for public health officials charged with improving the health of the nation.
- Source of data for facility planning and marketing.
- Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
- Ensure its accuracy.
- Better understand who, what, when, where and why others may access your health information.
- Make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. Requests for restrictions on disclosures to your health plan for health care items or services paid out of pocket must be accepted.
- Obtain a paper copy of the notice of information practices upon request.
- Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524 and HB 300 (paper or electronic).
- 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.
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
- Receive a notice of a breach of “unsecured” protected health information.
Our Responsibilities
This organization is required to:
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
- Abide by the terms of this notice.
- Notify you if we are unable to agree to a requested restriction.
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
- Notify you of a breach of “unsecured” protected health information.
We reserve the right to change our practices and to make the new provisions effective for all protected health information (PHI) we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied us.
We will not use or disclose or sell your health information without your written authorization, except as described in this notice.
To Report a Problem
If you have questions and would like additional information, you may contact the Privacy Officer at this office: Enrique Acosta, phone number: 7863686212.
If you believe your privacy rights have been violated, you can file a complaint with this office or with the secretary of Health and Human Services, 200 Independence Ave, SW Room 509F, HHH Building, Washington, D.C., 20201. 1(800)368-1019. There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
Treatment: Information obtained by a nurse, physician or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide subsequent healthcare providers with copies of various reports that should assist them in treating you.
Payment: A bill may be sent to you or a third-party payer. This information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
This notice is effective and revised as of July 29, 2019 and will remain in effect until revised.