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The purpose of this policy is to inform individuals of the policies and procedures to ensure the privacy of medical records, health information, and other types of personal information in accordance with HIPAA regulations.  This policy statement applies to any health care professional who is authorized to enter information in medical/health records.  HIPAA requires that covered entities handle personally identifiable, medical, and health information according to HIPAA regulations. 



This clinic can use or disclose medical information about an individual regarding his/her treatment, payment for services, and for clinic operations.


Treatment: Caregivers such as therapists may use an individual’s health information to determine current plan of care.  Employees and programs within this clinic may share health information about an individual in order to coordinate the services he/she may need, such as clinical examinations, therapy, or follow-up care.  This clinic may also use an individual’s health information to determine if his/her treatment is medically necessary or to ensure that proper treatment is being given.

Payment: This clinic may release information about an individual to Medicaid, his/her health plan or health insurance carrier to obtain payment for our services.  This clinic may also share an individual’s information, when appropriate, with other government programs in order to coordinate his/her benefits and payments.  This clinic may also tell an individual’s health plan about a treatment he/she is going to receive in order to obtain prior approval or to determine whether his/her plan will cover the treatment. 

To Other Government Agencies: This clinic may release an individual’s health information to other government agencies that are providing an individual with benefits or services when the information is necessary for him/her to receive those benefits and services. 

To Keep An Individual Informed: This clinic may contact an individual/caregiver about reminders for treatment or other medical services.  This clinic may also contact an individual/caregiver to tell him/her about health related benefits or services to give the individual/caregiver information about his/her managed care choices. 

For Public Health: This clinic may release an individual’s health information as it relates to public health, subject to the provisions of applicable state and federal law, for the following kinds of activities:

  • To prevent or control disease, injury or disability

  • To notify social service agencies that are authorized by law to receive reports of abuse, neglect, or domestic violence

For Health Oversight Activities: This clinic may share an individual’s health       information with other agencies for oversight activities as required by law.  Examples of these oversight activities include audits, inspections, investigations, and licensure.

For Law Enforcement: This clinic may release health information to a law enforcement official, subject to applicable federal and state law and regulations, for purposes that are required by law or in response to a court order or subpoena.

Lawsuits and Disputes: If an individual/caregiver is involved in a lawsuit or a dispute, this clinic may release health information in response to a court or administrative order.  This clinic may also release health information about an individual/caregiver in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell the individual/caregiver about the request or to obtain an order protecting the information requested.   


This clinic is required by state and federal law to maintain the privacy of an individual’s health information.  This clinic is required to give an individual this notice of its legal duties and privacy practices with respect to the health information that this clinic collects and maintains about the individual.  Clinics are required to follow the terms of this notice. 


This notice describes the permitted ways that an individual’s health information may be used or released.  Release of an individual’s information will be made only with an individual’s specific written authorization.  An individual may revoke specific authorizations to release information, in writing, at any time. 



Individual’s Health Information Rights:

Right to Inspect and Copy: Individuals have the right to inspect and obtain a copy of their health information.  This request may include medical, billing or health care payment information.  It does not include information that is needed for civil, criminal or administrative actions.  This clinic may charge a fee for the costs of copying, mailing or other supplies associated with an individual’s request. 

Right to Request Amendment: If an individual feels that the health information this clinic has created about him/her is incorrect or incomplete, he/she may ask us to amend that information.  This clinic may deny the request if an individual asks to amend information that: a) was not created by this clinic; b) is not part of the health information kept by this clinic; c) is not part of the information which the individual would be permitted to inspect or copy; or d) the information is determined to be accurate and complete.

Right to Accounting of Health Information Releases: Individuals have a right to request a list of information releases that this clinic has made of their health information.  The list will not include: a) health information releases made for purposes of providing treatment to an individual, obtaining payment for services or releases made for administrative or operational purposes; b) health information releases made for national security; c) health information releases made for law enforcement custodial situations. 

Right to Request Restrictions: Individuals have the right to request a restriction or limitation of the health care information this clinic uses or releases for treatment, payment or operational purposes.  This clinic is not legally required to agree to the requested restriction or limitation. 

Right to Request Confidential Communication: Individuals have the right to request this clinic communicate with them about health care matters in a certain way or at a certain location.  For example, an individual can request this clinic to only contact him/her at work or by e-mail.  This clinic will accommodate all reasonable requests.  To request confidential communication, an individual must specify how or where he/she wishes to do so. 

Right to a Paper Copy of This Notice: Individuals have the right to request a paper copy of this notice from this clinic at any time.

All requests for inspecting, copying, amending, making restrictions, or obtaining an accounting of an individual’s health information must be made in writing to this clinic.   



Please contact Becky Bassett or Kaylee Luttrell with questions or concerns. 

Changes to This Policy:

This clinic reserves the right to revise this policy.  This clinic reserves the right to make the revised policy effective for the health information it already has about an individual, as well as in information it creates or receives in the future.  This clinic will provide individuals with a copy of the revised policy within 60 days.  In addition, an individual may ask for a copy of the clinic’s current policy regarding privacy practices anytime.  

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