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NOTICE
OF 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 READ IT CAREFULLY. (CONT...)
Appointment
Reminders.
We
may use and disclose medical information to
contact you as a ...
- reminder
that you have an appointment or that you
should schedule an appointment.
- Treatment
Alternatives. We may use and disclose your
personal health information in order to tell
you about or recommend possible treatment
options, alternatives or health-related services
that may be of interest to you.
OTHER
USES AND DISCLOSURES OF PERSONAL INFORMATION
We
are required to obtain written authorization
from you for any other uses and disclosures of
medical information other than those described
above. If
you provide us with such permission, you may revoke that permission, in writing,
at any time. If you revoke your permission, we will no longer use or
disclose PHI about you for the reasons covered by your written authorization.
We will be unable to take back any disclosures already made based upon
your original permission.
INDIVIDUAL
RIGHTS
- You
have the right to ask for restrictions
on the ways in which we use and disclose
your medical
information beyond those imposed
by law. We will
consider your request, but we are not required to accept it.
- You
have me right to request that you receive communications
containing your PHI from us by alternative
means or at alternative locations. For example,
you may ask that we only contact you at home
or by mail.
- Except
under certain circumstances, you have the right
to inspect and copy medical and billing records
about you. If you ask for copies of this information,
we may charge you a fee for copying and mailing.
- If
you believe that information in your records
is incorrect or incomplete, you have the right
to ask us to correct the existing information
or correct the missing information. Under certain
circumstances, we may deny your request.
- You
have a right to ask for a list of instances
when we have used or disclosed your medical
information for reasons other than your treatment,
payment for services furnished to you, our
health care operations, or disclosures you
give us authorization to make. If you ask for
this information from us more than once every
twelve months, we may charge you a fee.
- You
have the right to a copy of this Notice in
paper form. You may ask us for a copy at any
time.
To
exercise any of your rights, please contact
us in writing at Privacy Officer ,
Santa Monica Imaging & Therapy Associates, Inc.
2428 Santa Monica Boulevard, Suite 302
Santa Monica, California
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