Our Privacy Policy

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.

The Health Informahon Portability & Accountability Act of 1996 (HIPAA) IS a federal program that
requires that all medical records and other Individually identifiable health Information used or
disclosed by us in any form, wheltler electronica lly, on paper, or orally, are kept properly
confldentlal. This Act gives you, the patienl, significant new rights to understand and control how
your health intormation is used. HIPAA provides penalhes tor covered entihes that misuse
personal health information.

We have prepared this explanation of how we are required to maintain the prrvacy ot your health information and how we may use and disclose your heatth information.

We may use and disclose your medical records only for the following purposes:

FOR TREATMENT: We may use health information about you to provide you with health care
treatment or services. We may disclose health information about you to doctors, nurses,
therapists, technicians, or other personnel who are involved In taking care of you. They may work at the hospitat if you are hospitatized under our supervision, or at another doctor's office, lab, rehabilitation facility, pharmacy, or other health care provider to whom we may refer you for
consultation, to take x-rays, to perform lab tests, physical therapy, prescription refills, or for other treatment purposes.

FOR PAYMENT: We may use and disclose health information about you so that the treatment and services you receive from us may be billed and payment collected from you, or an insurance company. Your health carrier may require access to your medica;0 information as a condition to providing your benefits. We may also use health Information to determine insurance benefits and eligibility or for utilization review.

FOR HEALTH CARE OPERATIONS: We may use and disclose health Information about you for
operations of our health care practice, such as conducting quality assessment and improvement
activities, auditing functions, cost management analysIs and customer service. We obtain services from business associates (an individual or entity under contract with us to perform or assist us in a function or activity that necessitates the use or disclosure of health Information) for credentiating, medical transcription, and medical review. We will share health information about you with our business associates as necessary to obtain these services We require our business associates to protect confidentiality of your health information.

APPOINTMENT REMINDERS: We may contact you to provide appointment reminders. Please let
us know if you do not wish to have us contact you concerning your appointment, or if you wish to
have us use a different telephone number or address to contact you for this purpose.

RESEARCH: We may collect and review information related to your prostate problem in order to
measure the outcomes of treatment. An ongoing critical review of treatment results is an important part of providing excellent medical care. Dr. Bans may wish to describe your case at medical meetings or in medical literature. Your identity will never be disclosed and all identifying
information is removed from any description of your case.

AS REQUIRED BY LAW: We will disclose health information about you when required to do so by federal, state, or local law.

SIGN IN SIGHT: We may use or disclose your health information by having you sign in when you
arrive at our office. We may also call out your name when we are ready to see you. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except
to the extent that we have already taken actions relying on your authorization.

YOUR HEALTH INFORMATION RIGHTS

The health and billing records we maintain are the physical property of the office. The information in it, however, belongs to you. You have the right to:

  • Request restrictions on certain uses and disclosures of protected health information,
    including those related to disclosures of family members, other relatives, close personal
    friends, or any other person identified by you. We are however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

  • Request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home rather than work. We will accommodate reasonable requests.

  • Inspect and obtain a copy of your protected health information. A request must be
    submitted in writing to Prostate Solutions of Arizona, 2525 E. Arizona Biltmore Circle, Suite C-236, Phoenix, AZ 85016.

  • The right to receive an accounting of disclosures of protected health information.

  • Obtain notice. We have the obligation to provide to you a paper copy of the Notice of
    Privacy Practices for Protected Health Information.

  • Request that your medical record be amended to correct incomplete or incorrect information by delivering a written request, including a reason to support it to our office
    using the form we provide to you upon request

OUR RESPONSIBILITIES

The office is required to

  • Maintain the privacy of your health information as required by law.

  • Provide you with Notice as to our duties and privacy practices as to the information we
    collect and maintain about you.

  • Abide by the terms of this Notice.

  • Notify you if we cannot accommodate a requested restriction or request.

  • Accommodate your reasonable requests regarding methods to communicate health
    information with you.

This notice is effective as of 2/1/04. We reserve the right to amend, change, or eliminate provisions in our privacy and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice.

You are entitled to receive a revised copy of the Notice upon request.

TO REQUEST INFORMATION OR FILE A COMPLAINT

If you believe your privacy rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services. To file a complaint with us, contact Frances Rangel, HIPAA Compliance Officer. All complaints must be submitted in writing. We cannot and will not retaliate against you for filing a complaint.

 

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