We are required by law to maintain the privacy of your protected health information, to notify you of our legal duties and privacy practices with respect to your health information, and to notify affected individuals following a breach of unsecured health information. This Notice summarizes our duties and your rights concerning your information. Our duties and your rights are set forth more fully in 45 CFR Part 164. We are required to abide by the terms of our Notice that is currently in effect.
Understanding Your Health Record/Information: Each time you visit a hospital, physician, or other health care provider, a record of your visit is generating. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for your future care or treatment. It may also contain correspondence and other administrative documents. All of 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 payor can verify that services billed were actually provided; A tool for educating health professionals; A source of data for medical research; A source of information for public health officials charged with improving the health of the nation; A source of data for planning and marketing; and A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
A Protected Health Information refers to information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.
Your Health Information Rights: Although your health record is the physical property of the health practitioner or facility that compiled it, the information belongs to you. You have the right to:
Inspect and copy your health record. In order to inspect or obtain a copy of your health record, you must submit a written request to ShaTerrica Moore at the address shown above. The form for your request to inspect or copy your health record is available at our office. Additionally, you can contact our office at the telephone number listed above and request that a copy of the form be mailed to you. If you request a copy of the information, we may charge a fee as permitted by Mississippi law for the costs of copying, mailing or other supplies associated with your request.
Your request to inspect and copy your health record can be denied by New Hope Medical Primary & Urgent Care in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
Amendment to your health record. If you feel that medical information maintained by New Hope Medical Care is incorrect or incomplete, you may submit in writing what changes or amendments that need to be made to the information. You have the right to request an amendment to your health record only during the time the information is kept by, or on behalf of, New Hope Medical Care .
To request an amendment, your request must be made in writing and submitted to ShaTerrica Moore at the address shown above. In addition, you must provide a reason that supports your request. The form for your request for an amendment to your health record is available at our office. Additionally, you can contact our office at the telephone number listed above and request that a copy of the form be mailed to you.
We may deny your request for an amendment to your health record if it is not in writing or does not include a reason that supports the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by New Hope Medical Primary & Urgent Care Clinic.
Was created by a person or entity who is no longer available to make the amendment;
Is not part of the medical information kept by or for this office;
Is not part of the information which you would be permitted to inspect and copy.
Or Is accurate and complete medical information.
If your request for an amendment is denied, you have the right to file a statement of disagreement. New Hope Medical Care also has the right to prepare a rebuttal to your statement of disagreement and will provide you with a copy of any rebuttal.
Request restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could request that we not use or disclose information about a medical procedure that you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.. To request restrictions, you must make your request in writing to New Hope Medical Care at the address listed above. In your request you must tell us (1) what information you want to limit; (2) whether you want to limit the use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your child. The form for your request for a restriction/ limitation on medical information disclosed is available at our office. Additionally, you can contact our office at the telephone number listed above and request that a copy of the form be mailed to you.
You may request additional restrictions on the use or disclosure of information for treatment, payment or healthcare operations. We are not required to agree to the requested restriction except in the limited situation in which you or someone on your behalf pays in full for an item or service, and you request that information concerning such item or service not be disclosed to a health insurer.
A copy of this notice. You have the right to obtain a copy of this notice. You may obtain a paper copy of this notice by contacting ShaTerrica Moore at the address listed above. Additionally, or printing this page from our website.
You can contact our office at the telephone number listed above and request that a copy of the form be mailed to you. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Request confidential communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You must make your request in writing to New Hope Medical Care Clinic at the address shown above. We will not ask you for the reason for your request. Your request must specify how or where you wish to be contacted.
Examples of Disclosures for Treatment, Payment and Healthcare Operations: The following are examples of when your health information can be disclosed pursuant to law:
We Will Use Your Health Information for Treatment.
We Will Use Your Health Information for Payment.
We Will Use Your Health Information for Healthcare Operations.
The following are examples of when your information may be disclosed:
Business Associates. There are some services provided to our practice through contracts with business associates. Examples of business associates include laboratory and pathology services, collection agencies, and a copying service used when making copies of your health record.
Notification. We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care of your location and general condition.
Communication with Family. Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person your identity, health information relevant to that persons involvement in your care or payment related to your care.
Research
Health Oversight Activities.
Judicial and Administrative Proceedings.
Deceased Person Information
Public Safety
National Security
Organ Procurement Organizations
Marketing
Food and Drug Administration (FDA)
Workers Compensation
Public Health
Correctional Institution
Law Enforcement
Change of Ownership
Other Disclosures. Federal law makes provisions 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 clinic standards and are potentially endangering one or more patients, workers or the public.
Uses and disclosures not described in this Notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes; for most marketing purposes; or if we seek to sell you information. You may revoke your authorization by submitting a written notice to the ShaTerrica Moore identified above. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.
Changes to this Notice. We reserve the right to change the terms of this Notice at any time and to make the new Notice effective for all protected health information that we maintain. If we change our privacy practices, we will post a copy of the current Notice in our reception area and on our website www.newhopemedicalcare.com. You may obtain a copy of the operative Notice form from our office manager or ShaTerrica Moore .
For More Information or to Report a Problem: If you have a question about our privacy policies or believe your privacy rights have been violated, you may contact ShaTerrica Moore 585 Tennessee Gas Road, Suite 5. Greenville, MS 38701. Phone number (662) 580-4506 Additionally, you may file a complaint with the Secretary of Safety of Health and Human Services. There will be no retaliation against an individual for filing a complaint.