Notice of Privacy Practices for Protected Health Information

This notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please read it
carefully!

Axon Health Associates is permitted by federal laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting symptoms, examination and test results, diagnosis,
treatment, and applying for future care or treatment. It also includes billing documents for those services.

 

Examples of uses of your health information for treatment purposes are:
  • A doctor obtains treatment information about you and records it in a health record
  • During the course of treatment, the doctor determines he/she will need to consult with another health care provider in the area. He she will share the information with such health care provider and obtain his/her input.
Examples of uses of your health information for payment purposes:
  • We may submit requests for payment to your health insurance company. The health insurance company (or other business associate helping us obtain payment) requests information from us regarding medical care given. We will provide information to them about you and the care given.
Examples of use of your information for health care operations:

We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services and insurance. We will share information about you with such insurers to other business associates as necessary to obtain these services. The health and billing records we maintain are the property of Axon Health Associates. The information in it, however, belongs to you. You have a right to:

  1. Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to this office – we are not required to grant the request but we will comply with any request granted;
  2. Obtain a paper copy of Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at this office.
  3. Request that you be allowed to inspect and copy your health record and billing record you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request.
  4. Appeal a denial of access to your protected health information except in certain circumstances.
  5. Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request. (We are not required to make such amendments)
  6. File a statement of disagreement if your amendment is denied, and require that the request for amendment and denial be attached in all future disclosures of you protected health information.
  7. Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include uses of information for treatment, payment or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.
  8. Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we give to you upon request; and
  9. Revoke authorizations that you made previously to use or disclose information except to the extent information or action has been taken, by delivering a written revocation to our office.

If you want to exercise any of the above rights, please contact Axon Health Associates in person or in writing, during normal business hours. We will provide you with assistance on the steps to take to exercise your right.

You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment and health care operation purposes.

Axon Health Associates is required to:

  • Maintain the privacy of your health information as required by law;
  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request; and
  • Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our notice. You are entitled to receive a copy of the revised copy of Notice by calling and requesting a copy of our Notice or by visiting our office and picking up a copy.

To request information or file a complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Jerad Dalton, DO.

Additionally if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to Axon Health Associates. You may also file a complaint by mailing or emailing it to the Secretary of Health and Human Services.

We cannot, and will not, require you to waive the right to file a complaint wit the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from Axon Health Associates.

We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

Other Disclosures and Uses

Notification – Unless you abject, we may use or disclose your protected health information to notify, or assist a family member, personal representative, or other person responsible for your care, about your location and about your general condition of your death.

Communication with Family – Using our best judgment, we may disclose to a family member, or other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement on your care or in payment for such care if you do not object to it in an emergency.

Disaster relief – we may use and disclose your protected health information to assist disaster relief efforts.

Funeral Directors or Coroners – We may disclose your protected health information to funeral direct ors or coroners consistent with applicable law to allow them to carry out their duties.

Organ Procurement Organizations – consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purposes of tissue donation and transplant.

Marketing – We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.

Worker’s Compensation – If you are seeking compensation through Workers compensation, we may disclose your protected health information to the extent necessary to comply with laws regarding Workers Compensation.

Public Health – As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, disability.

Abuse and Neglect – We may disclose your protected health information to the public authorities as allowed by law to report abuse or neglect

Correctional Institutions – If you are an inmate of a correctional institution, we may disclose to the institution or its agents the protected health information necessary for your health and the health and safety of other individuals.

Law Enforcement – We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or the extent an individual is the custody of law enforcement.

Judicial/Administrative Proceedings – We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.

Serious Threat to Health and Safety – To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious threat, imminent threat to the health or safety of a person or the public.

For Specialized Governmental Functions – We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to assistance program personnel.