YOUR RIGHTS REGARDING
YOUR HEALTH INFORMATION
Right To Inspect and Copy
You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy your health information, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY. You will be asked to complete a written authorization form. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies and services associated with your request. We may require that you pay such fee prior to receiving the requested copies.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right To Request Amendment
If you believe that our records contain information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY.
To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request. To obtain this form or to obtain more information concerning this process, please contact the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY.
We may deny your request for an amendment if you fail to complete the required form in its entirely. In addition, we may deny your request if you ask us to amend information that:
a] Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment
b] Is not part of the health information kept by or for the DONIPHAN CO.
HEALTH DEPT. / HOME HEALTH AGENCY
c] Is not part of the information that you would be permitted to inspect and
copy
d] Is accurate and complete
If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you, with certain exceptions specifically defined by law.
To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY.
Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY.
Right to Request Alternative Methods of Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request an alternative method of communications, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the DONIPHAN CO. HEALTH DEPT. / HOME HEALTH AGENCY. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.