Patient Privacy

ENTcare

NOTICE OF INFORMATION PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1ENTcare may use and disclose protected health information for treatment, payment and healthcare operations. Treatment options include, but are not limited to, insurance companies for claims including coordination of benefits with other insurers, and collection agencies. Healthcare operations include, but are not limited to, internal quality control and assurance including auditing of records.

2              ENTcare is permitted or required to use or disclose protected health information without the individual’s written consent or authorization in certain circumstances. Two examples of such are for public health requirements or court ordered subpoenas.

3              ENTcare will not make any other use or disclosure of a patient’s protected health information without the individual’s written authorization. Such authorization may be revoked at any time prior to the expiration date on the authorization form. Revocation must be written.

4              ENTcare may at times contact the patient to provide appointment reminders or information regarding treatment alternatives or other health-related benefits and services that may be of interest to the individual patient.

5              ENTcare will abide by the terms of the privacy notice currently in effect at the time of disclosure.

6              ENTcare reserves the right to change the terms of its notice and to make new notice provisions effective for all protected health information that it maintains.

7              ENTcare will provide each patient with a copy of any revisions of its Notice of Information Practice at the time of their next visit, or at their last known address if there is a need to use or disclose any protected health information of the patient. Copies may also be obtained at any time at our offices.

8              Any person/patient may file a complaint to the Practice and to the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with the practice, please contact one of the following Privacy Officers at the following addresses and/or phone number:

Cindy Austin, Privacy Officer 4300 W. Main St., Suite 403 Dothan, AL 36305 , David Halcomb, Privacy Officer (334) 793-4788

9              It is ENTcare policy that no retaliatory action will be levied against any individual who submits or conveys a complaint of suspected or actual non-compliance of the privacy standards.

 

10           Any patient may request ENTcare use reasonable, specific methods for confidential communication with them.

This facility is charged with accommodating such requests. All such requests for confidential communications must be made in writing and must be reviewed by a Privacy Officer.

 

11           For further information regarding this Privacy Notice or other questions regarding the Health Insurance Portability and Accountability Act, please contact one of the above Privacy Officers.

 

EFFECTIVE: 4-11-03 Revised: 3/2007

Houston Printing • 334¬792¬6651 • Form ENTNOI 08/11