IV. Uses and Disclosures Requiring Your Written
A. Use or Disclosure with Your Permission
(Authorization). For any purpose other than the ones
described above in Section III, we may only use or share
your PHI when you grant us your written permission
(authorization). For example, you will need to give us
your permission before we send your PHI to your life
B. Marketing. We must also obtain your written
permission (authorization) prior to using your PHI to
send you any marketing materials. However, we may
communicate with you about products or services related
to your Treatment, case management, or care
coordination, or alternative treatments, therapies,
health care providers, or care settings without your
V. Your Rights Regarding Your Protected Health
A. For Further Information; Complaints. If you
want more information about your privacy rights, are
concerned that we have violated your privacy rights, or
disagree with a decision that we made about access to
your PHI, you may contact our Privacy Office.
B. Right to Receive Confidential Communications.
You may ask us to send papers that contain your PHI to a
different location than the address that you gave us, or
in a special way. You will need to ask us in writing. We
will try to grant your request if we feel it is
reasonable. For example, you may ask us to send a copy
of your medical records to a different address than your
C. Right to Revoke Your Written Permission
(Authorization). You may change your mind about your
authorization by giving or sending a written "revocation
statement" to the Privacy Office at the address below.
The revocation will not apply to the extent that we have
already taken action where we relied on your permission.
D. Right to Inspect and Copy Your Health Information.
You may request access to your medical record file,
billing records, and other records used to make
decisions about your Treatment and payment for your
Treatment so you can review and/or ask for copies. Under
limited circumstances, we may deny you access to a
portion of your records. If you want to access your
records, you may obtain a record request form from the
Privacy Office. Return the completed form to the Privacy
Office. If you request copies, we will charge you the
amount listed on the rate sheet. We will also charge you
for our postage costs, if you request that we mail the
copies to you. For a copy of records, material, or
information that cannot routinely be copied on a
standard photocopy machine, such as x-ray films or
pictures, we may charge for the reasonable cost of the
E. Right to Amend Your Records. You have the
right to request that we amend PHI maintained in medical
record files, billing records, and other records used to
make decisions about your Treatment and payment for your
Treatment. If you want to amend your records, you may
obtain an amendment request form from the Privacy
Office. Return the completed form to the Privacy Office.
We will comply with your request unless we believe that
the information that would be amended is correct and
complete or that other circumstances apply.
F. Right to Receive an Accounting of Disclosures.
You may ask for an accounting of certain disclosures of
your PHI made by us on or after April 5, 2006. These
disclosures must have occurred before the time of your
request, and we will not go back more than six (6) years
before the date of your request. If you request an
accounting more than once during a twelve (12) month
period, we will charge you based on the rate sheet.
Direct your request for an accounting to the Privacy
G. Right to Receive Paper Copy of this Notice. If
you ask, you may obtain a paper copy of this Notice,
even if you have agreed to receive the notice
VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is effective as of
April 5, 2006.
B. Right to Change Terms of this Notice. We may
change the terms of this Notice at any time. If we
change this Notice, we may make the new notice terms
effective for all Protected Health Information that we
maintain, including any information created or received
prior to issuing the new notice. If we change this
Notice, we will post the new notice in the common area
of our our clinic, and on our Internet site at
http://www.arthritiscured.com. You also may obtain
any new notice by contacting the Privacy Office.