NOTICE OF CONFIDENTIALITY PRACTICES

IMPORTANT: THIS NOTICE DEALS WITH THE SHARING OF INFORMATION FROM YOUR MEDICAL RECORDS. PLEASE READ IT CAREFULLY

This notice describes your confidentiality rights as they relate to information from your medical records and explains the circumstances under which information from your medical records may be shared with others. The information in this notice also applies to others covered under your health plan, such as your spouse or children. If you do not understand the terms for this notice, please ask for further explanation (Chapter 323CHRS).

YOUR RIGHTS
Under the new law, you have the right to:

• Inspect and request copies of your medical records or to appeal any denial of your request for inspection or copying.
  
• Request that your health care provider append information to your medical record.
  
• Receive a notice of your privacy rights by your health plan upon enrollment, annually and when their confidentiality practices are substantially amended-
  
• Obtain a copy of this office's confidentiality practices.

USES OF INFORMATION
This office uses your protected health information to provide you with health care services. Under the law, your health information may also be used by such entities as health plans for the following purposes:

• Payment to physicians and hospitals who provide you with health care services- > Conducting quality assurance activities or outcomes assessments.
  
• Reviewing the competence or qualification of health care professionals.
  
• Performing accreditation, licensing or credentialing activities.
  
• Analyzing health plan claims or health care records data.
  
• Evaluating provider clinical performance.
  
• Carrying out utilization management.
  
• Conducting or arranging auditing services in accordance with statute, rule, or accreditation requirements.
  

Except for the purposes outlined above, your health information may not be disclosed without your authorization.

LIMITING DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
You have the right to limit disclosure of your protected health information if you choose to not use any health insurance or other third party payment as payment for services. In which case, you may only limit disclosure if you have advised the physician prior to the delivery of services and have paid for the health care services yourself.