Your Rights Regarding Your Protected Health Information
You have important rights concerning your PHI, and we are dedicated to upholding them. These rights include:
- Access Your Records: You can request to review and receive copies of your medical records in electronic or paper form.
- Request an Amendment: If you believe your medical records are incorrect or incomplete, you have the right to request corrections.
- Request Confidential Communications: You may ask us to contact you in a specific way or at a designated location, such as mailing information to your work address.
- Ask for Restrictions: You can request limits on how your information is used or shared for treatment, billing, or healthcare operations. We are not required to agree unless it involves disclosure to a health plan for a service paid in full.
- Obtain a List of Disclosures: You may request a record of certain disclosures of your PHI made within the past six years, excluding those for treatment, payment, and healthcare operations.
- Receive a Copy of This Notice: You are entitled to a paper copy of this Notice at any time, even if you chose to receive it electronically.
- Designate a Personal Representative: You can authorize someone to act on your behalf regarding your health information. Written authorization is required.
- File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Your Choices About How We Use and Share Your Information
For certain situations, you decide how we use or share your information. Without your written authorization, we will not share your information for:
- Family and Friends: Sharing with family, friends, or others involved in your care.
- Disaster Relief: Providing information to disaster relief organizations for notification purposes.
- Marketing and Fundraising: Using or sharing your information for marketing or fundraising efforts.
How We May Use and Disclose Your Information
We are permitted to use and share your PHI for the following purposes:
- Treatment: To provide medical care and coordinate services, including referrals to specialists.
- Healthcare Operations: For practice management, quality improvement, and other administrative needs.
- Billing and Payment: To bill you, your insurance, or a third party for services provided.
- Public Health and Safety: For activities such as preventing disease, reporting recalls, or assisting in health investigations.
- Research: For approved research studies, with appropriate safeguards.
- Legal Compliance: When required by federal or state law.
- Legal Proceedings and Law Enforcement: In response to court orders, subpoenas, or law enforcement requests.
Our Responsibilities to You
- Privacy and Security: We are required by law to protect the privacy and security of your PHI.
- Notice and Compliance: We must provide you with this Notice and follow the terms stated here.
- Authorization: We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice.
Changes to This Notice
We may update this Notice at any time. Any revisions will apply to all PHI we maintain. Updated versions will be available upon request in our office and posted on our website.
Compliance Officer
For questions, concerns, or to file a complaint about your privacy rights or this Notice, please contact our Compliance Officer at:
Manisha “Mona” Dave, MD – Pediatric Gastroenterology
13192 Dallas Pkwy, Ste 610, Frisco, TX.
Phone: 972-265-8222
