Notice of Privacy Practices HIPPA Act of 1996

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

Purpose: This Notice of Privacy Practice describes how we may use and disclose your Protected Health Information to carry out treatment, payment or healthcare operations and for other purposes permitted or required by law. Protected Health Information (PHI) is information that may identify the patient and that relates to the patient’s past, present or future physical or mental health, and may include name, address, phone numbers and other identifying information.

We are required to give you this notice and to maintain the privacy of your Protected Health Information. We must abide by this notice, but we reserve the right to change the privacy practices described in it. A current notice will be available at our office for repeat viewing if such need should arise.

If you believe that your privacy rights have been violated, you may complain to us or the U.S. Secretary of Health and Human Services. To file a complaint with us, you may send a letter describing the violation to the clinic at 9101 Kanis Road, Suite 300, Little Rock, AR 72205. This will be no retaliation for filing a complaint.

Who will follow this notice? This notice describes the practices of Arkansas Fertility and Gynecology Associates healthcare professionals and other employees involved in the healthcare delivery of the clinic.

Acknowledgement: You will be asked to sign an Acknowledgement of receipt of this notice. The delivery of healthcare services will in no way be conditioned upon the signing of this acknowledgement.

Your Privacy Rights. You have the following rights relating to our protected health information:

• Obtain a copy of the current notice
• Inspect or obtain a copy of your records. Your request to obtain a copy of your medical records must be in writing. You may be charged a fee for the cost of faxing or mailing a copying your records.h
• Request that we amend your record, if you feel the information is incomplete or incorrect. We are allowed to deny this request in certain circumstances and may ask you to put these request in writing and provide a reason that supports your request.
• Request in writing a restriction on certain uses and disclosures of your information. We are not required to agree to the requested restrictions in all circumstances.
• Obtain a record of certain disclosures of your PHI
• Make a reasonable request to have confidential communications of PHI sent to your by alternative means or at alternative locations.
• We will obtain your written permission for uses and disclosures of your PHI that are not covered by this notice or permitted by law.
• Submit any written requests to inspect copy or amend your records to the clinic address.

Examples of Uses and Disclosures:

We will use your PHI for treatment. Certain information obtained by a nurse, doctor, or other healthcare worker will be put into your record and used to plan and manage your treatment. We may provide reports or other information to your doctor or other authorized person who are involved in your care.

We will use your PHI for payment. A bill will be sent to you and/or to your insurance company with information about your diagnosis, procedures and supplies used.

Business Associates. We may share your PHI with outside people or companies who provide services for us, such as typing physician reports.

Notification. We may use or disclose your PHI to notify a family member (i.e. spouse), close personal friend, or parent involved in your care unless specifically instructed not to disclose information.

Contacts. We may contact you to provide appointment reminders or tell you about our new treatments and services.

Food and Drug Administration (FDA). We may share your PHI with certain governmental agencies like the FDA and CDC so they can recall drugs or equipment.

Communicable Diseases. We may disclose your PHI to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease, if authorized by law to do so, such as a disease requiring isolation. We may give your PHI to public health agencies who are charged with preventing or controlling disease or injury or disability and as required by law.

As required by Law. We must disclose your PHI when required by federal, state, or local law.

Abuse or Neglect. We must disclose your PHI to governmental authorities that are authorized by law to receive reports of suspected abuse or neglect.

Legal Proceedings. We may disclose your PHI in the course of any judicial or administrative proceedings or in response to a court order, subpoena, discovery request or other lawful purposes.

Required Uses and Disclosures. We must make disclosures when required by the Secretary of the Department of Health and Human safety to investigate or determine our compliance with the HIPAA Privacy Regulations.

To Avoid Harm. We may use and disclose information about you when necessary to prevent a serious threat to your health or safety of the health or safety of the public or another person.

Research. Your PHI may be used for research purposes in certain circumstances with your permission.