Cleveland Gilchrist, P.C.

Provider Notice of Privacy Practices

 

THIS NOTICE ÐESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY

BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Use and disclosure of health information:

We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.  Continuity of care is part of treatment and your records may be shared with other providers to whom you are referred.  Information may be shared by paper mail, electronic mail, fax, or other methods.

We may use or disclose identifiable health information about you without your authorization for several reasons. We may use this information to contact you and remind you of appointments. Subject to certain requirements, we may give out health information without your authorization for public health purposes, for auditing purposes, for research studies, and for emergencies.  We provide information when otherwise required by law, such as for law enforcement in specific circumstances.  In any other situation, we will ask for your written authorization before using or disclosing any identifiable information about you.  If you chose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures.

We may change our policies at any time.  Before we make a significant change in our policies we will change our notice and post the new notice in the waiting area.  You can also request a copy of our notice at any time.  For more information about our privacy practices, contact the person listed below.

 

Individual Rights:

In most cases, you have the right to look at or get a copy of health information about you that we use to make decisions about you.  If you request copies, we will charge you only the normal photocopy fees.  You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment or related administrative purposes and other than when you explicitly authorize it.  If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

 

Complaints:

If you are concerned that we have violated your privacy right, or you disagree with a decision we made about access to your records you may contact the person listed below:

 

Cleveland & Gilchrist, Privacy Officer

137 Clinic Drive

Dothan, AL 36304

(334) 699-2229

 

Our legal duty:

We are required by law to protect the privacy of your information, provide this notice about our information practices, follow the information practices that are describe in this notice, and obtain your acknowledgement of receipt of this notice.