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RIGHTS REGARDING YOUR
HEALTH INFORMATION
The law gives you many
rights regarding your health information. You can:
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Ask us to restrict our uses and disclosures
for purposes of treatment (except emergency treatment), payment
or health care operations. We do not have to agree to do
this, but if we agree, we must honor the restrictions that
you want. To ask for a restriction, send a written request
to our office.
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Ask us to communicate with you in a confidential way, such
as by phoning you at work rather than at home, by mailing
health information to a different address, or by sending
e-mail to your personal e-mail address. We will accommodate
these requests if they are reasonable, and if you pay us
for any extra cost. If you want to ask for confidential communications,
send a written request to our office.
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Ask to see or to get photocopies of your health information.
By law, there are a few limited situations in which we can
refuse to permit access or copying. For the most part, however
you will be able to review or have a copy of your health
information within 30 days of asking us (60 days if the information
is stored off-site). You may have to pay for photocopies
in advance. If we deny your request, we will send you a written
explanation, and instructions about how to get an impartial
review of our denial if one is legally available. By law,
we can have one 30-day extension of the time for us to give
you access or photocopies if we send you a written notice
of the extension. If you want to review or get photocopies
of your health information, send a written request to our
office.
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Ask us to amend your health information if you think it
is incorrect or incomplete. If we agree, we will amend the
information within 60 days from when you ask us. We will
send the corrected information to persons whom we know got
the wrong information and others that you specify. If we
do not agree, you can write a statement of your position,
and we will include it with your health information along
with any rebuttal statement that we may write. Once your
statement of position and/or our rebuttal is included in
your health information, we will send it when we make a permitted
disclosure of your health information. By law, we can have
one 30-day extension to consider a request for amendment
if we notify you in writing of the extension. If you want
to ask us to amend your health information, send a written
request, including your reasons for the amendment, to our
office.
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Get a list of the disclosures that we have made of your
health information within the past six years (or shorter
period). By law, the list will not include: disclosures for
purposes of treatment, payment or health care operations;
disclosures with your authorization; incidental disclosures;
disclosures required by law; and some other limited disclosures.
You are entitled to one such list per year without charge.
If you want more frequent lists, you will have to pay for
them in advance. We will usually respond to your request
within 60 days of receiving it, but by law we can have one
30-day extension if we notify you of the extension in writing.
If you want a list, send a written request to our office.
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Get additional paper copies of this Notice of Privacy
Practices. If you want additional copies, send a written
request to our office.
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