TARRY HOUSE, INC.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED. PLEASE REVIEW THIS NOTICE CAREFULLY AND ACKNOWLEDGE RECEIPT BY YOUR SIGNATURE AT THE END OF THIS NOTICE.
If you have any questions
about this notice please contact
This notice describes how Tarry House, Inc. may use and
disclose your protected health information. The terms of this Notice of Privacy Practices are
effective
USES AND DISCLOSURES
OF YOUR HEALTH INFORMATION
Tarry House is committed to maintain the confidentiality of your health information. However, your health information may be used and disclosed as customary and reasonable for purposes of treatment, payment, and health care operations and pursuant to a signed authorization form. You have the right to revoke that authorization in writing unless any action has been taken in reliance on the authorization.
Treatment, Payment
and Health Care Operations
This office will use and disclose your health information for purposes of treatment, payment and as otherwise necessary and permitted bylaw, for our health care operations. This may include disclosure to another health care provider who, at the request of your Doctor, becomes involved in your treatment, or for the purposes of approval of re-imbursement for services.
Business Associates
At times it may be necessary for us to provide your health information to certain outside persons or organizations that assist with our health care operations, such as accreditation bodies, legal services, auditing services, clinical reviews associates, etc. These business associates are required to properly safeguard the privacy of your health information.
Family and Friends
With your approval and using our professional judgment, your health information may be disclosed to designated family, friends and others who are directly involved in your care or in payment of your care. If you are unavailable, incapacitated, or in an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited health information with such individuals without your approval.
Other Uses and
Disclosures of your Health Information
Other uses and disclosures of your health information permitted or required by law may be made without your consent or authorization:
1. Use or disclosure of your health information for any purpose required by law.
2. Use or disclosure of your health information for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations.
3. Use or disclosure of your health information as required by law if we suspect child abuse or neglect, we may also release your individual health information as required by law if we believe you are a victim of abuse, neglect or domestic violence.
4. Use or disclosure of your health information if necessary to the Food and Drug Administration.
5. Use or disclosure of your health information to your employer when we have provided health care to you at the request of your employer.
6. Use or disclosure of your health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
7. Use or disclosure of your health information if required by a court or administrative ordered subpoena or discovery request, in most cases you will have notice of such release.
8. Use or disclosure of your health information to law enforcement officials.
9. Use or disclosure of your health information to coroners and/or funeral directors consistent with law.
10. Use or disclosure of your health information if you are a member of the military as required by armed forces services. We may release your individual health information if necessary for national security or intelligence activities.
11. Use or disclosure of your health information to workers’ compensation agencies.
12. Use or disclosure of your health information to the American Red Cross or other relief agencies.
YOUR RIGHTS
1. You have the right to request restrictions on some of our uses and disclosures of your health information.
2. You have the right to inspect and copy your health information maintained by Tarry House, Inc. All request
for access must be made in writing and signed by you or your guardian.
3. You have the right to request in writing that your health information maintained by this office be amended or corrected. In certain cases we may deny your request for amendment. If we deny your request, you may submit a statement of this disagreement to us and we may prepare a rebuttal that will be provided to you.
4. You have the right to receive an accounting of certain
disclosures made by us of your health information after