PF-1000 Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures
Your health information may be used by staff members or
disclosed to other health care professionals for the purpose of evaluating
your health, diagnosing medical conditions, and providing treatment. For
example, results of laboratory tests and procedures will be available in
your medical record to all health professionals who may provide treatment
or who may be consulted by staff members.
Your health information may be used to seek payment from your
health plan, from other sources of coverage such as an automobile insurer,
or from credit card companies that you may use to pay for services. For
example, your health plan may request and receive information on dates of
service, the services provided, and the medical condition being treated.
Health care operations.
Your health information may be used as necessary
to support the day-to-day activities and management of Sugar Lakes
Family Practice. For example, information on the services you received
may be used to support budgeting and financial reporting, and activities
to evaluate and promote quality.
Your health information may be disclosed to law enforcement
agencies to support government audits and inspections, to facilitate
law-enforcement investigations, and to comply with government mandated
Public health reporting.
Your health information may be disclosed to
public health agencies as required by law. For example, we are required to
report certain communicable diseases to the state’s public health
Other uses and disclosures require your authorization.
Disclosure of your
health information or its use for any purpose other than those listed
above requires your specific written authorization. If you change your
mind after authorizing a use or disclosure of your information you may