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Right to request how we contact you
It is my normal
practice to communicate with you at your home address and daytime phone
number you gave me when you scheduled your appointment, about health
matters, such as appointment reminders etc. Sometimes I may leave
messages on your voicemail. You have the right to request that my
office communicate with you in a different way.
Right to release your medical records
You may consent in writing to release your
records to others. You have the right to revoke this authorization, in
writing, at any time. However, a revocation is not valid to the extent
that I acted in reliance on such authorization
Right to inspect
and copy your medical and billing records.
You have the right
to inspect and obtain a copy of your information contained in my medical
records. You may request access to your billing or health information.
Under limited circumstances, I may deny your request to inspect and copy
records. If you ask for a copy of any information, I may charge a
reasonable fee for the costs of copying, mailing and supplies.
Right to add
information or amend your medical records.
If you feel that information contained in
your medical record is incorrect or incomplete, you may ask me to add
information to amend the record. I will make a decision on your request
with 60 days, or some cases within 90 days. Under certain circumstance,
I may deny your request to add or amend information. If I deny your
request, you have a right to file a statement that you disagree. Your
statement and my response will be added to your record. I will require
you to submit your request in writing and to provide an explanation
concerning the reason for your request.
Right to request restrictions on
uses and disclosures of your health information.
You have the
right to ask for restrictions on certain uses and disclosures of your
health information. This request must be in writing. However, I am not
required to agree to such a request.
Right to complain.
If you believe
your privacy rights have been violated, please contact me personally,
and discuss your concerns. If you are not satisfied with the outcome,
you may file a written complaint with the U.S. Department of Health and
Human Services. An individual will not be retaliated against for filing
such a complaint.
receive changes in policy.
You have the right
to receive any future policy changes secondary to changes in state and