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 CAREFULLY

YOUR PRIVATE HEALTH INFORMATION (PHI)

Each time you have contact with a healthcare provider, a record of your contact is prepared. This record may contain information such as signs, symptoms, results of examinations or tests, diagnoses, treatment, or future care plans. Your medical record is the physical property of Nicholson Clinic, but you have certain rights regarding the use and disclosure of your private health information (PHI). Nicholson Clinic however, has the right to use and disclose your PHI in the process of providing treatment, receiving payment and performing other regular healthcare operations such as:

  • Documenting and describing the care you received for legal purposes
  • Communicating with other healthcare providers involved in your care
  • Educating healthcare professionals
  • Medical Research
  • Providing information for government and public health entities
  • Evaluating and improving the care you receive and the outcomes achieved
  • Billing and verification of services provided to you
  • Conducting other routine healthcare operations

Protecting your privacy and maintaining the security of your PHI is an important responsibility of this practice. We are required by law to maintain privacy and confidentiality of your PHI, notify you of your rights in regards to your PHI, inform you of these privacy practices prior to gaining consent to treat, and notify you of changes/revisions to this Notice of Privacy Practices.

You may file a complaint with the Nicholson clinic if you suspect any privacy rights violation. We will investigate the inquiry and inform you of the finding. In addition, you have the right to file a complaint with the Secretary of the Department of Health and Human Services.

EXAMPLES OF DISCLOSURE OF YOUR (PHI)

Healthcare delivery and treatment:
Your PHI may be provided to other healthcare professionals, such as other physicians, specialists, therapists, hospital based providers, and or other healthcare providers.

Billing and payment:
Your PHI is utilized to justify the level of care delivered to you and the charges incurred for the services. This information generally accompanies the bill and is sent to your payers and other third party administrators.

Other healthcare operations:
You PHI may be disclosed to other businesses in order for my practice to perform its day-to-day operations. These may include business associates such as vendors, contractors used for credentialing and peer review, patient satisfaction surveys, utilization review, billing and claims management, medical research, disease control, quality improvement initiatives, management services organizations, laboratories, free standing diagnostic facilities, transcription services, and legal counsel. All business associates are required to appropriately protect the confidentiality of your PHI.

Treatment:
We may instruct a specialist to contact you to schedule an appointment or to provide you with information on treatment.

Other uses and disclosures:
We may utilize and disclose your PHI with others concerned with your health such as family members, relatives, caregivers, employers, and funeral directors. In addition, we may disclose your PHI through other communications and reports required to be made by healthcare professionals such as the public health department, law enforcement, the Food and Drug Administration, organ procurement organizations, corrections institutions, and workers compensation, where applicable.

Other disclosures of PHI not permitted or required by law will be made only with your written authorization You may revoke your authorization at any time provided that the revocation is in writing, except to the extent that Nicholson Clinic has already taken action in reliance on your prior authorization.

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