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Privacy
Policy
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version of policy.
NOTICE OF PRIVACY
POLICIES AND PRACTICES
FOR BOULDER ENDOCRINOLOGY, PLLC
DEAR PATIENT:
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW IT CAREFULLY.
INTRODUCTION
At Boulder Endocrinology, PLLC we are committed to
treating and using protected health information about
you responsibly. This Notice describes the personal
information we collect, and how and when we use or
disclose that information. It also describes your rights
as they relate to your protected health information.
This Notice is effective January 5, 2009 and applies to
all protected health information as defined by federal
regulations.
UNDERSTANDING YOUR MEDICAL RECORD / HEALTH INFORMATION
Each time you visit Boulder Endocrinology, PLLC a record
of your visit is made. Typically, this record contains
information about your visit including your examination,
diagnosis, test results, treatment as well as other
pertinent healthcare data. This information, often
referred to as your health or medical record, serves as
a:
Basis for planning your care and treatment
Means of communication with other health professionals involved in
your care
Legal document outlining and describing the care you
received
A tool that you, or another payer (your insurance
company) will use to verify that services billed were
actually provided
An education tool for medical health providers
A source for medical research
Basis for public health officials who might use this
information to assess and/or improve state as well as
national healthcare standards
A source of data for planning and / or marketing
A tool that we can reference to ensure the highest
quality of care and patient satisfaction
Understanding what is in your record and how your health
information is used helps you to ensure its accuracy,
determine what entities have access to you health
information, and make an informed decision when
authorizing the disclosure of this information to other
individuals.
YOUR 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
OUR RESPONSIBILITIES
Boulder Endocrinology, PLLC is required to:
Maintain the privacy of your health information
Provide you with this 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 regarding
communication of health information via alternative
means and/ locations
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. Whatever the
reason for these revisions, we will provide you with a
revised notice on your next office visit. The revised
policies and practices will be applied to all protected
health information that we maintain.
We will not use or disclose your health information
without your authorization, except as described in this
notice. We will also discontinue to use or disclose your
health information after we have received a written
revocation of the authorization according procedures
included in the authorization.
HOW WE MAY USE AND/OR DISCLOSE YOUR HEALTH INFORMATION
We will use your health information for 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.
We will use your information for payment. Your health
plan may request and receive information on dates of
service, the services provided, and the medical
condition being treated in order to pay for the service
rendered to you.
We will use your information for regular health
operations. Your health information may be used as
necessary to support the day-to-day activities and
management of Boulder Endocrinology, PLLC. For example:
information on the services you received may be used to
support budgeting and financial reporting, and
activities to evaluate and promote quality.
Business Associates. In some instances, we have
contracted separate entities to provide services for us.
These “associates” require your health information in
order to accomplish the tasks that we ask them to
provide. Some examples of these “business associates”
might be a billing service, collection agency, answering
services and computer software/hardware provider.
Communication with family. Due to the nature of our
field, we will use our best judgment when disclosing
health information to a family member, other relatives,
or any other person that is involved in your care or
that you have authorized to receive this information.
Please inform the practice when you do not wish a family
member or other individual to have authorization to
receive your information.
Research / Teaching / Training. We may use your
information for the purpose of research, teaching, and
training.
Healthcare Oversight. Federal law requires us to release
your information to an appropriate health oversight
agency, public health authority or attorney, or other
federal/state appointee if there are circumstances that
require us to do so.
Public health reporting. Your health information may be
disclosed to public health agencies as required by law.
Law enforcement. Your health information may be
disclosed to law enforcement agencies, without your
permission, to support government audits and
inspections, to facilitate law-enforcement
investigations, and to comply with government mandated
reporting.
Appointment reminders. The practice may use your
information to remind you about upcoming appointments.
Typically, appointment reminders are sent by mail in a
closed envelope, or, a brief, non-specific message may
be left on your answering machine. If you don’t approve
of these methods, or, if you prefer alternative methods
(i.e., email) please inform the practice.
Other uses and disclosures. 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.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have complaints, questions or would like
additional information regarding this notice or the
privacy practices of Boulder Endocrinology, PLLC please
contact:
Boulder Endocrinology, PLLC
892 W. South Boulder Rd.
Louisville, CO 80027
If you believe that your privacy rights have been
violated, please contact the aforementioned practice
Privacy Official, or, you may file a complaint with the
Office for Civil Rights, U.S. Department of Health and
Human Services. There will be no retaliation for filing
a complaint with either the practice’s Privacy Official
or with the Office for Civil Rights. The address for the
Office for Civil Rights is listed below:
OFFICE FOR CIVIL RIGHTS
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C., 20201
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