Legacy Male health Institute, P.A. Notice of 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 REVIEW IT CAREFULLY.
Notice of Privacy Practices in compliance with HIPAA
Each time you have contact with a healthcare provider, a record of
your visit is prepared. This record contains demographics,
presenting signs/symptoms, results of the examination and tests,
diagnoses, treatment and future care. Your medical record is the
physical property of the medical practice, but you have certain
rights to restrict some of the uses or disclosures of the
information in your medical record. Male Fertility Specialists,
P.A., however, has the right to use and disclose the information
contained in your medical record for the following:
Uses and Disclosures
Treatment
Your health information may be used by staff members or
disclosed to other health care professionals for the purpose of
evaluating your health, diagnosing medical conditions, and providing
treatment. For example, results of laboratory tests and procedures
will be available in your medical record to all health professionals
who may provide treatment or who may be consulted by staff members.
Payment
Your health information may be used to obtain reimbursement for
services, confirming coverage, billing or collection activities, and
utilization review.
Health care operations
Your health information may be used as necessary to support the
day-to-day activities and management of Male Fertility Specialists,
P.A.. For example, information on the services you received may be
used to support budgeting and financial reporting, and activities to
evaluate and promote quality.
Law enforcement
Your health information may be disclosed to law enforcement agencies
to support government audits and inspections, to facilitate
law-enforcement investigations, and to comply with government
mandated reporting.
Public health reporting
Your health information may be disclosed to public health agencies
as required by law. For example, we are required to report certain
communicable diseases to the state's public health department.
Other uses and disclosures require your authorization. Disclosure of
your health information or its use for any purpose other than those
listed above requires your specific written authorization. If you
change your mind after authorizing a use or disclosure of your
information you may submit a written revocation of the
authorization. However, your decision to revoke the authorization
will not affect or undo any use or disclosure of information that
occurred before you notified us of your decision to revoke your
authorization.
Additional Uses of Information
Appointment reminders
Your health information will be used by our staff to send you
appointment reminders.
Information about treatments. Your health information may be used to
send you information that you may find interesting on the treatment
and management of your medical condition..
Individual Rights
You have certain rights under the federal privacy standards. These
include:
- the right to request restrictions on the use and disclosure of your protected health information
- the right to receive confidential communications concerning your medical condition and treatment
- the right to inspect and copy your protected health information
- the right to amend or submit corrections to your protected health information
- the right to receive an accounting of how and to whom your protected health information has been disclosed
- the right to receive a printed copy of this notice
Legacy Male Health Institute, P.A. Duties
Protecting your privacy and maintaining the security of your health
information is one of the most important responsibilities of Legacy
Male Health Institute, P.A. We are required by law to maintain
the privacy of your protected health information and to provide you
with this notice of privacy practices. We also are required to abide
by the privacy policies and practices that are outlined in this
notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our
privacy policies and practices. These changes in our policies and
practices may be required by changes in federal and state laws and
regulations. Upon request, we will provide you with the most
recently revised notice on any office visit. The revised policies
and practices will be applied to all protected health information we
maintain.
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information
that we maintain. As permitted by federal regulation, we require
that requests to inspect or copy protected health information be
submitted in writing. You may obtain a form to request access to
your records by contacting our receptionist or Privacy Officer. Your
request will be reviewed and will generally be approved unless there
are legal or medical reasons to deny the request.
Complaints
If you would like to submit a comment or complaint about our privacy
practices, you can do so by sending a letter outlining your concerns
to:
Attn: Privacy Officer
Legacy Male Health Institute, P.A.
5616 Warren Parkway, Suite 101
Frisco, Texas 75034
If you believe that your privacy rights have been violated, you
should call the matter to our attention by sending a letter
describing the cause of your concern to the same address. You
will not be penalized or otherwise retaliated against for filing a
complaint.
Contact Person
The name and address of the person you can contact for further
information concerning our privacy practices is:
Privacy Officer
Legacy Male Health Institute, P.A.
5616 Warren Parkway, Suite 101
Frisco, Texas 75034
972-612-7131 Ext. 202
Effective Date
This Notice is effective on or after April 14, 2005.
Thank you for visiting Legacy Male Health Institute, P.A., Learn more about our privacy policy at Vasectomyreversal.com.
