Dr. Shelby Glazer & Dr. Richard Ruffini 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 REVIEW IT CAREFULLY.
Dr. Shelby Glazer & Dr. Richard Ruffini is required, by law, to maintain the privacy and confidentiality
of your protected health information and to provide our patients with notice
of our legal duties and privacy practices with respect to your protected health
information.
Disclosure of Your Health Care Information
Treatment
We may disclose your health care information to other healthcare professionals
within our practice for the purpose of treatment, payment or healthcare operations.
(example)
“On occasion, it may be necessary to seek consultation regarding
your condition from other health care providers associated with Dr. Shelby Glazer & Dr. Richard Ruffini.”
“It is our policy to provide a substitute health care provider,
authorized by Dr. Shelby Glazer & Dr. Richard Ruffini to provide assessment and/or treatment to our patients,
without advanced notice, in the event of your primary health care provider’s
absence due to vacation, sickness, or other emergency situation.”
Payment
We may disclose your health information to your insurance provider for the purpose
of payment or health care operations.
Workers’ Compensation
We may disclose your health information as necessary to comply with State Workers’
Compensation Laws.
Emergencies
We may disclose your health information to notify or assist in notifying a family
member, or another person responsible for your care about your medical condition
or in the event of an emergency or of your death.
Public Health
As required by law, we may disclose your health information to public health
authorities for purposes related to: preventing or controlling disease, injury
or disability, reporting child abuse or neglect, reporting domestic violence,
reporting to the Food and Drug Administration problems with products and reactions
to medications, and reporting disease or infection exposure.
Judicial and Administrative Proceedings.
We may disclose your health information in the course of any administrative
or judicial proceeding.
Law Enforcement.
We may disclose your health information to a law enforcement official for purposes
such as identifying or locating a suspect, fugitive, material witness or missing
person, complying with a court order or subpoena, and other law enforcement
purposes.
Deceased Persons.
We may disclose your health information to coroners or medical examiners.
Organ Donation.
We may disclose your health information to organizations involved in procuring,
banking, or transplanting organs and tissues.
Research.
We may disclose your health information to researchers conducting research that
has been approved by an Institutional Review Board.
Public Safety.
It may be necessary to disclose your health information to appropriate persons
in order to prevent or lessen a serious and imminent threat to the health or
safety of a particular person or to the general public.
Specialized Government Agencies.
We may disclose your health information for military, national security, prisoner
and government benefits purposes.
Change of Ownership.
In the event that Dr. Shelby Glazer & Dr. Richard Ruffini is sold or merged with another organization, your
health information/record will become the property of the new owner.
Your Health Information Rights
- You have the right to request restrictions on certain uses and disclosures
of your health information. Please be advised, however, that Dr. Shelby Glazer & Dr. Richard Ruffini is
not required to agree to the restriction that you requested.
- You have the right to have your health information received or communicated
through an alternative method or sent to an alternative location other than
the usual method of communication or delivery, upon your request.
- You have the right to inspect and copy your health information.
- You have a right to request that Dr. Shelby Glazer & Dr. Richard Ruffini amend your protected health
information. Please be advised, however, that Dr. Shelby Glazer & Dr. Richard Ruffini is not required to
agree to amend your protected health information. If your request to amend
your health information has been denied, you will be provided with an explanation
of our denial reason(s)and information about how you can disagree with the
denial.
- You have a right to receive an accounting of disclosures of your protected
health information made by Dr. Shelby Glazer & Dr. Richard Ruffini.
- You have a right to a paper copy of this Notice of Privacy Practices at
any time upon request.
Changes to this Notice of Privacy Practices
Dr. Shelby Glazer & Dr. Richard Ruffini reserves the right to amend this Notice of Privacy Practices at any
time in the future, and will make the new provisions effective for all information
that it maintains. Until such amendment is made, Dr. Shelby Glazer & Dr. Richard Ruffini is required by law
to comply with this Notice.
Dr. Shelby Glazer & Dr. Richard Ruffini is required by law to maintain the privacy of your health information
and to provide you with notice of its legal duties and privacy practices with
respect to your health information. If you have questions about any part of
this notice or if you want more information about your privacy rights, please
contact: Dr. Shelby Glazer by calling this office at 248.353.2225. If Dr. Shelby Glazer is not available,
you may make an appointment for a personal conference in person or by telephone
within 2 working days.
Complaints
Complaints about your Privacy rights, or how Dr. Shelby Glazer & Dr. Richard Ruffini has handled your health
information should be directed to Dr. Shelby Glazer or Dr. Richard Ruffini, by calling this office at 248.353.2225
If Dr. Shelby Glazer or Dr. Richard Ruffini is not available, you may make an appointment for a personal conference
in person or by telephone within 2 working days.
If you are not satisfied with the manner in which this office handles your
complaint, you may submit a formal complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
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