Notice Of Maricopa OB/GYN Privacy Practices
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
Uses and Disclosures
Treatment. Your health information may be used by our staff members or disclosed to other
health care professionals for the purpose of evaluating your health, diagnosing medical conditions,
and providing treatment. For example, results of laboratory tests and procedures will be available
in your medica record to all health professionals who may provide treatment or who may be
consulted by staff members
Payment. Your health information may be used to seek payment from your health plan or from
other sources of coverage such as an automobile insurer. For example, your health plan may
request and receive information on dates of service, the services provided, medical condition
being treated, and past medical history pertaining to the condition being treated. Your health
information will also be used in obtaining benefit information and prior authorization for treatment
and requesting and acknowledging referrals.
Health care operations. Your health information may be used as necessary to support the day-
to-day activities and management of Maricopa OB/GYN. For example, information on the
services you received may be used to support budgeting and financial reporting, and activities to
evaluate and promote quality.
Appointment reminders. Your information will be used by our staff to contact you regarding
Law Enforcement. Your health information may be disclosed to law enforcement 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
states public health department.
Other uses and disclosures require your authorization. Disclosure of your health information
or its use for any purpose other than those listed above requires your specific written
authorization. If you change your mind after authorizing a use or disclosure of your information
you may submit a written revocation of the authorization. However, your decision to revoke the
authorization will not affect or undo any use or disclosure of information that occurred before you
notified us of your decision to revoke your authorization.
You have certain rights under the federal privacy standards. These include:
- the right to request restrictions on the use and disclosure of your protected health information
- the right to receive confidential communications concerning your medical condition and treatment
- the right to inspect and copy your protected health information
- the right to amend or submit corrections to your protected heath information
- the right to receive an accounting of how and to whom your protected health information has been disclosed
- the right to receive a printed copy of this notice
Maricopa OB/GYN Duties
We are required by law to maintain the privacy of your protected health information and to
provide you with this notice of privacy practices.
We also are required to follow the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices.
These changes in our policies and practices may be required by changes in federal and state laws
and regulations. 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
Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information that we maintain. As
permitted by federal regulation, we require that requests to inspect or copy protected health
information be submitted in writing. You may obtain a form to request access to your records by
contacting our check in desk or our privacy officer. Your request will be reviewed and will
generally be approved unless there are legal or medical reasons to deny the request.
If you would like to submit a comment or complaint about our privacy practices, you can do so by
sending a letter outlining your concerns to:
1661 E Camelback, Suite 160
Phoenix, AZ 85016
If you believe that your privacy rights have been violated, you should call the matter to our
attention by sending a letter describing the cause of your concern to the same address.
You can view federal government information regarding HIPAA at the United States Department of Health & Human Services website.