Notice of Privacy Practices

Our Legal Duty

Alvin-Manvel Family Clinic ("we," "us," "our") is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to notify you following a breach of unsecured PHI. We are required to abide by the terms of this Notice while it is in effect.

We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. Revised notices will be posted in our office and on this website.

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your PHI to provide you with medical treatment and services, to coordinate and manage your health care, and to communicate with other healthcare providers involved in your treatment. For example, a physician or nurse practitioner treating you may need to share information about your condition with a specialist or consulting provider.

Payment

We may use and disclose your PHI to bill and receive payment from health plans, insurers, and other payers for the services we provide to you. For example, we may send your diagnosis and procedure codes to your insurance company to obtain payment for an office visit.

Health Care Operations

We may use and disclose your PHI for our health care operations, which include activities such as quality assessment and improvement, business planning, training of health care students and professionals, accreditation, and other activities necessary to run our practice.

Other Permitted Uses and Disclosures

We may also use or disclose your PHI without your authorization for the following purposes:

• As required by law
• Public health activities (e.g., reporting communicable diseases)
• Health oversight activities (e.g., audits and investigations)
• Judicial and administrative proceedings, when required by court order
• Law enforcement purposes as required by law
• To avert a serious threat to health or safety
• Workers' compensation claims
• Coroners, medical examiners, and funeral directors
• Research authorized by an Institutional Review Board
• Military and national security activities

Uses and Disclosures Requiring Authorization

Other uses and disclosures of your PHI — including most disclosures for marketing purposes, sale of your PHI, and most uses of psychotherapy notes — require your written authorization. You may revoke an authorization at any time in writing, except to the extent that we have already relied on the authorization.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your medical records and billing records. We may charge a reasonable fee. To request access, contact our office in writing.

Right to Amend

If you believe your medical records contain an error or are incomplete, you may request that we amend them. We may deny your request under certain circumstances.

Right to an Accounting of Disclosures

You have the right to receive an accounting of disclosures of your PHI made by us in the six years prior to your request, except for disclosures made for treatment, payment, and healthcare operations, and certain other disclosures.

Right to Request Restrictions

You have the right to request that we restrict how we use or disclose your PHI for treatment, payment, and healthcare operations, and to individuals involved in your care. We are not required to agree to a restriction, except in one circumstance: if you pay in full out of pocket for a service and ask us not to disclose related information to your health plan, we must comply.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your health care in a specific way or at a specific location. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time by contacting our office.

Right to Opt Out of Fundraising

We may contact you for fundraising purposes. You have the right to opt out of receiving such communications at any time.

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights.

To file a complaint with us: Contact our Privacy Officer at:

To file a complaint with HHS: Visit www.hhs.gov/ocr or call 1-800-368-1019. You will not be retaliated against for filing a complaint.

Contact Us

If you have questions about this Notice or about your privacy rights, please contact us at (832) 532-4426 or info@amfclinic.com.