Effective February 1, 2013:
information. This includes ways we can use and ways we can give out your information in regards to payment, health care and other purposes that the law permits or requires. We will describe your rights on withholding your own information below.
Ways that we can use or give out your personal health information include:
Patient Treatment: only to help manage, provide or coordinate patient healthcare, including to other
physicians as necessary if the patient is under their care.
Payment: we may disclose some information to receive payment for services that were provided to the patient, including a third-party if they are paying the patient's bill.
Our Own Evaluation: we may disclose some patient information if we are evaluating our services and performance, including our third-party associates, such as billing, transcription or consultation services.
Reminding of Appointments: we may contact the patient to remind them if they made an appointment.
Alternative Treatments: we may contact other services that can help give our patients better treatment success.
Research: we may release patient information to review boards conducting approved research under
thoroughly protected protocols.
When Required by Law: we will disclose necessary information when we are required to do so by the law.
Avoiding Serious Threats to Public Safety: we will disclose protected health information only to an
authority figure within the public health realm if the sole purpose is to control or prevent injury, disease
or disability. This includes foreign agencies if they are collaborating directly with this authority on
Workman's Compensation: we have to disclose private health information during a program such as
worker's compensation in order to provide health benefits for work-related illness or injury.
Your Healthcare Rights
You also have the right to your own health information at any time. The record may be owned by the doctor, the information contained in that record is yours.
You have the right to read through your information at any time and you can go through your medical record, including bills, at your discretion. We will provide it to you in a timely manner once we are given the request in writing by the patient.
You have the legal right to amend your own medical information if for some reason you feel as though something was erroneous or left out. This request must also be put into writing and given to someone at the reception desk within one of our offices.
We have the right to deny this request if you do not give it to us in writing or it has no reason attached
for the request.
We can also deny giving you access to information that we did not create that may be in your medical
You have the right to limit how we disclose and use your personal information if you put it in writing and give it to the manager of one of our offices.
We do not have to agree to your request if it is in the patient's best interest to use that information in the way it has been used.
You can request a list that shows all disclosures of your personal information that we have given to
people beyond our own practice if it was not for treatment, healthcare or payment. This request must
also be made in writing and it has to have specific dates that the information needs to cover. The
request cannot go back beyond six years because we do not have to hold information longer than that.
One request is free, but beyond that we have the right to charge a fee.
You can request that we communicate privately with you in order to keep your information private, and this can be narrowed down by phone, address or other method of communication. This request must also be made in writing and it needs to include methods you feel comfortable being contacted through. We will do our best to accommodate your request in this regard.
You also have the right to file a complaint if you believe that your rights were knowingly violated. Thisright needs to be given directly to our practice manager or to the US Secretary of Health and Human Services.
Disclosures or Alternative Uses Not Previously Covered
Any other use for your personal information must be requested by us in writing to you. You have the
right to deny this authorization at any point in time if you put it in writing, and from that point forward,
we will not share any additional healthcare information without once again getting your written
authorization. The denial is not retroactive to cover information shared prior to when you withdrew
If you have any questions or are requesting additional information, please call AGIS at (318)448-5310.