PHI can be disclosed with your authorization in the following categories.

You may request a limitation or restriction on the disclosure of this information. You have the right to:

• request a restriction or limit of any of the above disclosures used for treatment, payment, or office operations.
• inspect and copy information that may be used to make decisions about your care. 
• request an amendment of this information if you feel it is incorrect or incomplete. 
• an accounting of disclosures we have made that were not related to treatment, payment, or operations of this office.

These requests must be submitted in writing to the office manager and you will be informed of the specifics that are required.

Treatment - PHI will be used to provide appropriate treatment either by this office or other healthcare providers, diagnostic or fabrication laboratories.

Payment - PHI will be used to facilitate payment for treatment rendered.  Your health plan requires this information in order to bill, collect payments, or obtain approval prior to treatment.

Healthcare Operations - In order to ensure all patients receive timely and quality care, PHI will be used to facilitate the daily operations of our practice.  These include, but are not limited to:

•   clinical/research studies to improve our practice
•   appointment reminders by phone calls or mailings
•   sign-in sheets used to notify us of your arrival
•   posted appointment schedules
•   information regarding your treatment options or related benefits and services
•   communications with family or friends that are involved in your care or payment for your care

PHI can be disclosed without your authorization

in the following categories.

As Required by Law

Judicial and Administrative Proceedings

Oversight

PHI can be disclosed to a health oversight agency as authorized by law for audits, investigations, inspections, and licensure.

Public Health

Lawsuits and Disputes

Workers’ Compensation

PHI may be released to workers' compensation or similar programs that provide benefits for work-related injuries or illness.

Public Health Risks

Law Enforcement

Military and Veterans

Health Research

PHI disclosures

are permitted

when required

by federal, state,

tribal, or local laws.

Coroners and Medical Examiners

Release of PHI to officials will occur: in response to a court order, subpoena, discovery request or summons; to identify a suspected fugitive, witness, or missing person; about a victim of crime if unable to obtain permission from the person; to identify a deceased person, determine cause of death, about a death that is believed to be the result of criminal conduct; criminal conduct occurring at the practice; in emergency situations.

National Security and Intelligence Activities

Abuse, Neglect, or Domestic Violence

PHI can be disclosed to prevent a threat

to your health and safety

or the health and safety of others.

Cadaver Organ, Eye, or Tissue Donations

PHI disclosure can be made to organ banks as necessary to facilitate organ or tissue donation and transplantation.

Protective Services for the President and Others

PHI may be released as authorized by law when requested by military command authorities, federal officials for national security, and protection of the president and other heads of state.