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TREATMENT: 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, a doctor may use the information
in your medical record to determine which treatment option,
such as a drug or surgery, best addresses your health needs.
PAYMENT: Your health information may be used to seek payment
from your health plan, from other sources of coverage such
as an auto insurer or from credit card companies that you
may use to pay for services.
HEALTH CARE OPERATIONS: Your health information may be used
as necessary to support day-to-day activities and management
of the Buffalo Otolaryngology Group. For example, information
may be used to support budgeting and financial reporting and
activities to evaluate and promote quality.
LAW ENFORCEMENT: 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 reporting.
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 public health department.
OTHER USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION: Other
disclosure of your health information or its use for other
than the reasons listed above requires your specific written
authorization. If you change your mind after authorizing,
you may submit a written revocation of the authorization.
However, you revocation will not affect or undo any use or
disclosure that occurred before you notified us of your decision.
ADDITIONAL USES OF INFORMATION: Your health information will
be used by our staff to send any appointment reminders deemed
necessary.
INDIVIDUAL RIGHTS: You have certain rights under federal
privacy standards including:
- the right to request restrictions on the use and disclosure
of your health information
- the right to receive confidential communications concerning
your medical condition and treatment
- the right to inspect and copy your health information
- you can request to amend or submit corrections to your
health information
- the right to receive an accounting of how and to whom
your health information was disclosed
- the right to receive a printed copy of this summary and
the Buffalo Otolaryngology Group's Notice of Privacy Practices,
which provides a more complete description of information
uses and disclosures.
BUFFALO OTOLARYNGOLOGY GROUP DUTIES: We are required to maintain
the privacy of your health information and to provide you
with our Notice of Privacy Practices. We reserve the right
to amend or modify our privacy policies and practices. Upon
request, we will provide you with the most recently revised
notice on any office visit. The revised policies and practices
will be applied to all protected health information we maintain.
- You may generally inspect or copy your health information.
As permitted by federal regulation, we require that such
request must be submitted in writing to: BUFFALO OTOLARYNGOLOGY
GROUP. Your request will be reviewed and will generally
be approved unless there are legal or medical reasons to
deny your request.
- If you would like to submit a comment or complaint about
our privacy practices (you will not be penalized or otherwise
retaliated against for filing), you may submit a lettering
outlining your concerns to: Shelly Chodora, Business Manager,
Buffalo Otolaryngology Group, 897 Delaware Avenue, Buffalo,
NY 14209.
- For further information concerning our privacy policies,
please contact: Shelly Chodora at the above address.
- The effective date of this notice is APRIL 14, 2003.
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