As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A
PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW
YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH
THIS NOTICE ALSO ALLOWS YOU TO UNDERSTAND OUR SECURITY AND PRIVACY
The following categories describe the different ways in which we may use and disclose your IIHI.
1. Treatment. Our practice may use your IIHI to treat you. Additionally, we may also disclose your IIHI to other health care providers for purposes related to your
2. Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us.
Also, we may use your IHII to bill you directly for services and items.
3. Health Care Operations. Our practice may use and disclose your IIHI to operate our business.
4. Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options and alternatives.
6. Health-Related Benefits and Services. Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest
7. Release of Information to Family/Friends. Our practice may use and disclose your IIHI to a friend or family member that is involved in your care, or who
assists in taking care of you.
8. Disclosures Required by Law. Our practice may use and disclose your IIHI when we are required to do so by federal, state, or local law.
USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
1. Public Health Risks. Our practice may use and disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
(A) maintaining vital records, such as births and deaths
(B) reporting child abuse or neglect
(C) preventing or controlling disease, injury or disability
(D) notifying a person regarding potential exposure to a communicable disease
(E) notifying a person regarding a potential risk for spreading or contracting a disease or condition
(F) reporting reactions to drugs or problems with products of devices
(G) notifying individuals if a product or device they may be using has been recalled
(H) notifying appropriate gonverment agency (ics) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence);
however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
(I) notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
2. Health Oversight Activities. Our practice may use and disclose your IIHI to a health oversight agency for activities authorized by law.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit
or similar proceeding.
4. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:
(A) Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
(B) Concerning a death we believe has resulted from criminal conduct.
(C) Regarding criminal conduct at our offices.
(D) In response to a warrant, summons, court order, subpoena or similar legal process.
(E) To identify/locate a suspect, material witness, fugitive or missing person.
(F) In an emergency, to report a crime (including the location of victim (s) of the crime, or the description, identity or location of the perpetrator).
5. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If
necessary, we also may release information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practive may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including
organ donation banks, as necessary to facilitate organ or tissue donation and trasplantation if your are an organ donor.
7. Research. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use
your IIHI for research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies
(i) the use or disclosure involves no more than minimal risk to your privacy based on the following:
(A) an adequate plan to protect the identifiers from improper use and disclosure;
(B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification
for retaining the identifiers or such retention is otherwise required by law); and
(C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized
oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted;
(ii) the research could not practicably be conducted without the waiver; and
(iii) the research could not practicably be conducted without access to and use of the PHI.
8. Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and
safety or the health and safety of another individual or the public.
9. Military. Our practice may use and disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the
10. National Security. Our practice may use and disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We also
may disclose your IIHI to federal officials in order to protect officials or foreign heads of state.
11. Inmates. Our practice may use and disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law
enforcement official. Disclosure for these purposes would be necessary:
(A) for the institution to provide health care services to you,
(B) for the safety and security of the institution, and/or
(C) to protect your health and safety of other individuals.
2. Personal Identification and Form Submission. All forms created on this MFA are capable of being filled out while still reviewing the website. However, they can only be saved onto your personal computer or printed by your personal printer. No personal information will be saved by our logs, servers, or this website after you have filled it out. Therefore, all paperwork (such as patient registration forms) are required to be physically brought in to your appointment as MFA will retain no information that you have filled out a form from the website. All final paper submissions must be done in person with a legal form of identification available to confirm your identity in association with the paperwork.
The only exception will be a job application. Although the job application will follow the same print/save only criteria as all other forms, the website may potentially offer submission capability through our server. You have the option to e-mail or submit via upload. We will do this as securely as possible, but MFA will not guarantee the safety of your information completely. All e-mails will be received through a secure server.
3. Internet Cookies. Internet cookies on your computer hard drive may be placed by our website. Any information obtained from the cookie will not be personal. It will not contain your identification or healthy history. MFA may utilize two type of “cookies”: one is known as a ‘session’ cookie and one is known as a ‘peristent cookie.’
Session cookies are temporary and expire once you have left our website and closed your browser. These types of cookies help us to see your experience within our site and maintain your signed-on status while you may be logged into our site.
Persistent cookies will remain on your hard drive. A persistent cookie gives us the ability to remember you. For example, if you have asked us to remember your login information on your site, the persistent cookie will enable that to happen.
If you have software or deactivated your internet cookies, some features of this site may not work properly for you. If you would like instructions on how to deactivate these cookies, please see your browser’s help file.
4. Minors. MFA does not knowingly allow or request that anyone under the age of 13 review, participate, or create accounts for this site.
5. E-mails. Any e-mails sent for anything on this website is sent to a secure server. The information you provide may be stored within this secure server for further research and evaluation or until the problem or application is resolved or documented appropriately. By sending the e-mail, you have given MFA permission to allow our own staff members to review what you have sent or asked. Each e-mail will be reviewed by the most qualified staff member who is able to answer any question. Please remember: if you are having an emergency, an e-mail is not the best method to contact your provider. Please call your primary care office, go to your local urgent care, or call 911 depending on the severity of your issue. The MFA website and e-mail capabilities are specifically used for job inquiries, FAQ, feedback, research and evaluation, and quality improviement within our website and our offices. Any e-mail address or information you provide within these e-mails will only be used for the purposes of responding to you directly. No information will be transferred or sold outside of the confines of MFA or our secured server.
6. Research and Feedback. We request feedback with this website using surveys, questionnaires, and areas for comment. We request feedback on the site, feedback on the facilities, as well as any support questions a site viewer may have. We will not ask for any specific medical information. We may ask for some general demographic information, such as name, age, or gender. The information provided will be utilized to improve the MFA website, our information, and our in-office services to the best of our abilities. The information may be stored on a secure server for future reference and further evaluation.
7. Payment Information. Although we may provide you with information on how to make a payment, this website does not currently take actual payments nor ask you for your personal payment information (such as bank account numbers or credit cards). We do take over-the-phone payments within our billing office and we provide you with the correct, safe phone number on our “Payment Options” page. If you are asked to fill in payment information for any reason on this website, please stop immediately and report it by sending a secured e-mail to: email@example.com
8. Disclosure. MFA retains the right to disclose any personal information to any person(s) or legal systems performing legal, operational, audit, or other services. We will attempt discrepency with personal, identifiable information to the best of our abilities unless required otherwise by law. We will also disclose any personal information if it relates to public safety. We will report any activity that is deemed in violation of law. We will disclose any personal information to protect the security of this website and its users and to take any precaution against liability as necessary.