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.
With your consent, this practice is permitted by federal privacy laws to make uses of and disclosures of your health information for purposes of treatment, payment , and health care operations. Protected health information is information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment and applying for future care or treatment. It also includes billing documents for those services.
Your Health Information Rights
The health record we maintain and billing records are the physical property of the practice. The information in it, however, belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office. We are not required to grant the request, but we will comply with any request granted.
- Obtain a paper copy of this Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office.
- Request that you be allowed to inspect and copy your health record and billing record. You may exercise this right by delivering the request in writing to our office.
- Appeal a denial of access to your protected health information except in certain circumstances.
- Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office.
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.
- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care.
- Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office.
- Revoke authorization that you made previously to us except to the extent information or action has already been taken by delivering a written request to our office.
If you want to exercise any of these rights, please contact our Office Manager Legacy Surgery Phone Number 540-437-1230 or Toll Free at 877-449-4123 or 2071 Pro Pointe Lane, Harrisonburg, Virginia 22801 in person or in writing during business hours which are 7:30am to 4:00pm. The Office Manager will provide you with assistance on the steps to take to exercise these rights.
You have the right to review this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.
To Request Information or File a Complaint:
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact our Office Manager, at Legacy Surgery Phone Number 540-437-1230 or Toll Free at 877-449-4123.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to our Office Manager at 2071 Pro Pointe Lane, Harrisonburg, Virginia. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Resources. We cannot and will not require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment. We cannot and will not retaliate against you for filing a complaint with the Secretary.
Effective Date: August 1, 2010