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HIPAA Policy


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.

What is your medical information?  All the health care related information we have in your file, including your medical history, current condition, diagnosis, examination notes, test results, X-rays and prescriptions.

Why are you getting this Notice?  We must comply with the HIPAA Privacy Rule that requires us to protect the confidentiality of your medical information.  The Privacy Rule also gives you certain rights with respect to your medical information.  This Notice explains both our obligations and your rights under the Privacy Rule.

We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all PHI that we maintain by first:

We may legally use and disclose your PHI as follows:

  1. We may use and disclose PHI about you to provide health care treatment to you. We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example, we may use and disclose PHI about you when you need a prescription, lab work, an x-ray, or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider.
  1. We may use and disclose PHI about you to obtain payment for services. Generally, we may use and give your medical information to others to collect payment for the treatment and services provided to you. For example, we may also share portions of your medical information with the following:
  1. We may use and disclose your PHI for our internal health care operations. We may use and disclose PHI in performing business activities, which we call “health care operations”. These “health care operations” allow us to improve the quality of care we provide and reduce health care costs. Examples of the way we may use or disclose PHI about you for “health care operations” include the following:

4. We may use and disclose PHI under other circumstances without your prior written authorization. We may use and/or disclose your PHI under a number of circumstances in which you do not have to consent, give authorization or otherwise be given an opportunity to agree or object. Those circumstances include:

  1. You can object to certain uses and disclosures. Unless you object, we may use or disclose your PHI in the following circumstances:

If you would like to object to our use or disclosure of PHI about you in the above circumstances, please call our contact person listed below.

  1. We may contact you to provide appointment reminders. We may use and/or disclose PHI to contact you to provide a reminder to you about an appointment you have for treatment or medical care.
  2. We may contact you with information about treatment, services, products or health care providers.We may use and/or disclose PHI to manage or coordinate your healthcare. This may include telling you about treatments, services, products and/or other healthcare providers.

EXAMPLE: If you are diagnosed with diabetes, we may tell you about nutritional and other counseling services that may be of interest to you.

** ANY OTHER USE OR DISCLOSURE OF YOUR PHI 
REQUIRES YOUR PRIOR WRITTEN AUTHORIZATION **

Under any circumstances other than those listed above, we will ask for your prior written authorization before we use or disclose your PHI. If you sign a written authorization allowing us to disclose your PHI in a specific situation, you may later cancel your authorization in writing. If you cancel your authorization in writing, we will not disclose your PHI after we receive your cancellation, except for disclosures, which were being processed before we received your cancellation.

  1. YOUR RIGHTS.
  1. You have the right to request restrictions on uses and disclosures of PHI about you.

You have the right to request that we restrict the use and disclosure of your PHI. We are not required to agree to your requested restrictions. However, if we do agree to your request we will abide by the restrictions except under the following circumstances: emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures described in the previous sections of this Notice. You may request a restriction by submitting your request in writing.

  1. You have the right to request different ways to communicate with you. You have the right to make reasonable requests with regard to how and where we contact you about your PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing and we must accommodate reasonable requests.
  2. You have the right to see and copy PHI about you. You have the right to request to see and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. We may charge you related copying and/or summary preparation fees. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial.
  3. You have the right to request amendment of your medical record. You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for requesting the amendment. We may deny your request if: 1) the information was not created by us (unless you prove the creator of the information is no longer available to amend the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete; or 4) you would not have the right to see and copy the record as described above. We will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received your PHI and who need the amendment.
  4. You have the right to a listing of disclosures we have made. If you ask our contact person in writing, you have the right to receive a written list of certain of our disclosures of your PHI. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are not required to include disclosures:

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The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure. If you request a list of disclosures more than once in 12 months, we may charge you a reasonable fee.

You have the right to a copy of this Notice. You have the right to request a paper copy of this Notice at any time. We will provide a copy of this Notice no later than the date you first receive services from us (except for emergency services, and then we will provide the Notice to you as soon as possible).

III.       YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES.  If you think your privacy rights have been violated by us, or you want to complain to us about our privacy practices, you may contact the person listed below:

Dr. Kenneth Raskin

Wisconsin Hormone Institute
at BodyLogicMD of Milwaukee

9000 West Chester Street, Suite 210, 
Milwaukee, WI 53214

You may also send a written complaint to the United States Secretary of the Department of Health and Human Services.  If you file a complaint, we will not take any action against you or change our treatment of you in any way.

Effective date of this Notice: November l, 2012 until revised or revoked.

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