Your rights regarding your health information:
- RIGHT TO INSPECT AND COPY. You have the right to inspect and copy your medical and billing records by written request to Eric Levander, M.D., M.P.H. You must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. You will receive a response from us within 30 days of us receiving your written request. Exceptions to patient rights to access, inspect, and copy PHI are: psychotherapy notes, information that a health care professional thinks could be a serious harm to you, information for use in a civil or criminal trial or administrative proceeding, and certain laboratory information. If we deny your request, we will give you, in writing, the reasons for your denial. We may charge a reasonable, cost-based fee for copies.
- RIGHT TO AMEND. You have the right to request an amendment to your records by written request to Eric Levander, M.D., M.P.H. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. You will receive a response within 60 days of our receipt of your request. We may deny your request, in writing, if we find that the health information is (a) correct and complete, (b) forbidden to be disclosed, (c) not part of our records, or (d) written by someone other than us. Our denial must be in writing and must state the reason for the denial. It must also explain our right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and our denial be attached to any future disclosure of your health information. If we approve your request, we will make the changes(s) to your health information. Additionally, we will tell you that the change has been made, and we will advise all others who need to know about the change (s) to your health information.
- RIGHT TO AN ACCOUNTING OF DISCLOSURES. You have a right to an accounting of certain disclosures by written request to Eric Levander, M.D., M.P.H.
- RIGHT TO REQUEST RESTRICTIONS. You have the right to request restriction or limitation on your health information used for treatment, payment or health care operations. You may request us to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request to Eric Levander, M.D., M.P.H. We are not required to agree with your request, but we will try to comply.
- RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that we contact you only by mail or at work. Your written request must specify how or where you wish to be contacted and be addressed to Eric Levander, M.D., M.P.H. We will accommodate reasonable requests.
Changes to this notice:
We may change this notice and make it effective for medical information we already have about you as well as new information. The current notice will be posted and available at all times. You have a right to request a paper copy of the current notice at any visit or by written request to Eric Levander, M.D., M.P.H.
Effective Date: July 20, 2003
