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 to Protect your Rights.
Your health information is personal, and we are committed to protecting it. Your accurate health information is also very important to our ability to provide you with quality care and to comply with certain laws.
The law requires us to have your written authorization for some uses and disclosures. In other circumstances, the law allows us to use or disclose PHI without your written authorization. Some types of PHI, such as drug and alcohol abuse, patient treatment information, HIV test results, mental health information, and genetic testing results, may be subject to greater protection of your privacy with more restrictions on our use or disclosure of PHI. In general, we disclose a minor patient's PHI to a parent or guardian, but in some situations, we may deny the parents access to the minor patient's PHI.
This section explains and shows examples of each of these disclosure situations:
Other uses and disclosures of your PHI that are not covered by this Notice or the laws that apply to us will be made only with your written permission. You may revoke that permission, in writing, at any time. If you do, we will no longer use or disclose your PHI for the purposes specified in the written authorization, but we cannot take back any disclosures we have already made with your permission, and we are required to keep certain records of the uses and disclosures made when the authorization was in effect.
You may ask us to limit how we use and disclose your PHI, as long as you are not asking us to limit uses and disclosures that we are required to make. Requests must be submitted in writing. We are not required to agree to your request, but if we do, we will put it in writing and will abide by the agreement except when you require emergency treatment.
You may ask that we send information to you at a specific address (for example, at work rather than at home) or in a specific manner (for example, by telephone rather than by regular mail). We must agree to your request as long as we believe it is reasonable and we determine that it would not be disruptive to our procedures.
Except for limited circumstances, you may look at and copy your PHI if you ask in writing to do so. If you ask us to copy your PHI, we will charge you $15 for up to 30 pages, $0.35 per page thereafter (paper or digital).
If you believe that the PHI we have about you is incomplete or incorrect, you may ask us to amend it. Requests must be made in writing, and tell us why you think the amendment is appropriate.
The list will not include disclosures made for our treatment, payment and health care operations purposes, those made directly to you or your family or friends. The list will not include disclosures made with your written authorization, for national security purposes or to law enforcement personnel, disclosure of limited data set, or disclosures made before April 4, 2003.
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7447 Egan Drive, Suite 207,
Savage, MN 55378
info@arisewellnessmed.com
952-522-6344
952-855-2800(hablamos español)
Monday - Friday
9:00am - 5:00pm
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