Notice of Privacy Practices to Our Patients:
This notice describes how health information about you (as a
patient of AACI Foot, Leg and Ankle care) may be used and disclosed, and how
you can get access to your health information. This is required by the Privacy
Regulations created as a result of the Health
Insurance Portability and Accountability Act of 1996 (HIPPA).
Our Commitment to your Privacy:
Our practice is dedicated to maintaining the privacy of your
health information. We are required by law to maintain the confidentiality of
your health information. We realize that these laws are complicated, but we
must provide you with the following information:
Use and disclosure of your health information in certain
special circumstances:
The following circumstances may require us to use or
disclose your health information:
1.
To public health authorities and health
oversight agencies that are authorized by law to collect information.
2.
Lawsuits and similar proceedings in response to
a court or administrative order.
3.
If required to do so by a law enforcement
official.
4.
When necessary to reduce or prevent a serious
threat to your health and safety or the health and safety of another individual
or the public. We will only make disclosures to a person or organization able
to prevent the threat.
5.
If you are a member of U.S. or foreign military
forces (including veterans) and if required by the appropriate authorities.
6.
To federal officials for intelligence and
national security activities authorized by law.
7.
To correctional institutions or law enforcement
officials if you are an inmate or under the custody of a law enforcement
official.
8.
For Workers Compensation and similar programs.
Your rights
regarding your health information:
1.
Communications: You can request that our
practice communicate with you about your health and related issues in a
particular manner or at a certain location. For instance, you may ask that we
contact you at home rather than at work. We will accommodate reasonable
requests.
2.
You can request a restriction in our use or
disclosure of your health information for treatment, payment, or health care
operations. Additionally, you have the right to request that we restrict our
disclosure of your health information to only certain individuals involved in
your care or the payment for your care, such as family members and friends. We
are not required to agree to your request; however, if we do agree, we are
bound by our agreement except when otherwise required by law, in emergencies, or
when the information is necessary to treat you.
3.
You have the right to inspect and obtain a copy
of the health information that may be used to make decisions about you,
including patient medical records and billing records, but not including
psychotherapy notes. You must submit your request in writing to (Squire Foot
and Ankle PLLC Chad A. Squire, Privacy officer, 932 S. Main St. Unit B203,
Snowflake, AZ, 83937).
4.
You may ask us to amend your health information
if you believe it is incorrect or incomplete, as long as
the information is kept by or for our practice. To request an amendment, your
request must be made in writing and submitted to (Squire Foot and Ankle PLLC
Chad A. Squire, Privacy officer, 932 S. Main St. Unit B203, Snowflake, AZ,
83937). You must provide us with a reason that supports your request for
amendment.
5.
Right to a copy of this notice. You are entitled
to receive a copy of this notice of Privacy Practices. You may ask us to give
you a copy of this Notice at any time. To obtain a copy of this Notice, contact
our front desk receptionist.
6.
Right to file a complaint. If you believe your
privacy rights have been violated, you may file a complaint either directly
with the practice, or to the Secretary of the Department of Health and Human
Services. To file a complaint with our practice, contact (Squire Foot and Ankle
PLLC Chad A. Squire, Privacy officer, 932 S. Main St. Unit B203, Snowflake, AZ,
83937). All complaints must be submitted in writing. You will not be penalized
for filing a complaint.
7.
Right to provide an authorization for other uses
and disclosures. Our practice will obtain your written authorization for uses
and disclosures that are not identified by this notice or permitted by
applicable law. If a disclosure of your protected health information was made
for a reason other than treatment, payment or health
care operations, you have a right to receive an accounting of the disclosures.
If you have any questions regarding this notice or our
health information privacy policies, please contact Squire Foot and Ankle PLLC
at (928) 457-0961 for further questions.