Notice of Privacy Practices - Policy and Procedure
John R Knudsen, MD 6046 Portal Way #103 Ferndale, WA 98248
Phone: 360-483-5260, Fax: 360-483-5264
Purpose
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.
John R Knudsen, MD and staff respect your privacy. We understand that your personal health information is very sensitive. The law protects the privacy of the health information we create and obtain in providing care and services to you. Your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. We will not use or disclose your health information to others without your authorization, except as described in this Notice, or as required by law.
Your health information rights.
The health and billing records we create and store are the property of John R Knudsen, MD. The protected health information in it, however, generally belongs to you. You have a right to:
For help with these rights during normal business hours, please contact 360-483-5260..
Our responsibilities
We reserve the right to change our privacy practices and the terms of this Notice, and to make the new privacy practices and notice provisions effective for all of the protected health information we maintain. If we make material changes, we will update and make available to you the revised Notice upon request. You may receive the most recent copy of this Notice by calling and asking for it, by visiting our [office/medical records department] to pick one up, or by visiting our Web site, if we maintain one.
To ask for help or complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact Koe at 360-483-5260.
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member.
You may also deliver a written complaint to Administrator at this office. You may also file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR). We respect your right to file a complaint with us or with the OCR. If you complain, we will not retaliate against you.
How we may use and disclose your protected health information.
Under the law, we may use or disclose your protected health information under certain circumstances
without your permission. The following categories describe the different ways we may use and disclose your protected health information without your permission. For each category, we will explain what we mean and
give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose health information will fall within one of the categories.
Below are examples of uses and disclosures of protected health information for treatment, payment, and health care operations.
In addition, other uses and disclosures of your health information that are not described in this Notice will be
made only with your written authorization. You have the right to cancel prior authorizations for these uses and disclosures of your health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we receive the revocation. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
This notice is effective as of May 1, 2013
