THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY GHENT FAMILY PRACTICE AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY

EFFECTIVE April 14, 2003:

Under the HIPAA Privacy regulations, Ghent Family Practice (“GFP”) and all similar healthcare providers are required by federal law to maintain the privacy of your protected health information (“PHI”) and will abide by the terms in this Privacy Notice.

Please be advised that under Federal Law GFP may use your PHI in a number of situations: A). We will use such information in rendering treatment to you. For example, we are permitted to use your PHI in providing you with medical care/treatment when you visit our office or we treat you in a hospital or nursing facility. B). We may disclose your PHI as necessary to third parties for treatment. For example, if we refer you to a specialist, we will forward you medical information to said specialist. C). We can disclose your PHI for payment purposes. For example, we will disclose your PHI to your insurance provider, employer, Medicare, Medicaid or other party responsible for providing you with health insurance coverage in order for GFP to be reimbursed for our services rendered to you. D). We will use or disclose your PHI for health care operations. For example, we may use your PHI when we engage in quality assurance and medical chart reviews, which are part of our health care operations. E). We will disclose your PHI when required by the Secretary of Health and Human Services.

Our practice may also use or disclose you PHI in accordance with the specific requirements of the HIPAA rules without GFP needing to obtain your authorization if any of the following instance(s) occur:
Required by law; required for public health purposes; required disclosures about victims of abuse, neglect or domestic violence; required by a health oversight agency for oversight activities authorized by law; required in the course of any judicial or administrative proceeding; required for a law enforcement purpose to a law enforcement official; required by a coroner or medical examiner; required by an organ procurement organization; for research; and if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

We may also contact you via US Postal Service mail, email, or phone to remind you of appointments with our office or to discuss treatment alternatives.

In the event our practice wishes to disclose your PHI to another entity besides those referenced above, we are required to obtain your authorization. For example, if we desired to participate in outside research or a drug study, we would need your written authorization prior to being permitted to release your PHI to such outside research facility or drug manufacturer. If you provide us with an authorization, you retain the right to revoke such authorization at any time by sending GFP a written revocation. If, however, we have already released such information pursuant to your prior authorization, the revocation will be effective for all future disclosures only.

Please be further advised that you have the right to access, copy, inspect and amend your medical information that we maintain. Additionally, if you desire, GFP can provide you with an accounting of all disclosures that we have made of your PHI to third parties, except such disclosures necessary for treatment, payment, or health care operations and other permitted HIPAA exceptions.

If you have a dispute with our practice regarding our use of your PHI or a disclosure by GFP and believe that your privacy rights have been violated, please contact Mary Jo Gambert, the Ghent Family Practice Office Manager/Privacy Officer to file a dispute or you may contact the Secretary of Health and Human Services. (Dispute forms are available on our web site or you can send an email to OCRComplaint@hhs.gov). Please understand that GFP will not retaliate against you in any way for filing a complaint. {Make the email address a link}

Lastly, please be advised that you have the right to request restrictions on certain use and disclosures of your PHI to carry out treatment, payment, or health care operations. You also have the right to restrict or permit the release of certain aspects of your PHI by GFP to a family member, relative or a close personal friend. We are, however, not required by Federal Law to agree to your requested restriction. If you request a copy of your PHI, you may also request that we send it to an alternative location (different address) or by alternative means. GFP reserves the right to amend this Notice as revised. Notices will be posted on our website (www.ghentfamilypractice.com), in our office and provided to you upon your request.

Thank you. If you have any questions, please direct them to Mary Jo Gambert, Office Manager

Click Here For Our Privacy Complaint Form