Notice of Privacy Practices
We make a record of your visit at each appointment. This record contains your symptoms, examination and diagnoses, treatment and plan for your future care or treatment. This information (health or medical record) serves as a:
- Basis for planning your care and treatment
- Means of communication among the health professionals who contribute to your care
- Legal document describing the care you received
- Means by which you or a third-party payer can verify that services billed were provided
- Source of information for public health officials charged to improve the health of the state and nation
Clinicians will use this information to contact you for the purpose of:
- Providing appointment reminders
- Describing or recommending treatment alternatives
- Purposes as required by law or in response to a valid subpoena
We may do the following unless I specifically give direction prohibiting such activity:
- Send routine correspondence, such as billing statements, to the address I provided
- Send text message appointment reminders to the mobile number I provided
- Send email to the email address I provided for appointment reminders, patient education, and other communications that do not contain protected patient health information
- Leave messages on an answering machine or voice mail associated with the telephone numbers I provided to confirm appointments or request that I call Auxano Psychiatric NP Services on medical or billing matters
- Share billing and clinical information (including protected health information or PHI) with the company performing billing services
- Share billing information with the person who holds the insurance I provide to secure payment.
Your Health Information Rights
Although your health record is the physical property of Auxano Psychiatric NP Services PLLC, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information
- Obtain a paper copy of the notice of information practices upon request
- Inspect and copy your health records as provided by 45 CFR,164.524
- Amend your health record as provided by 45 CFR, 164.526
- Obtain an accounting of disclosures of your health information as provided by 45 CFR, 164.528
- Request confidential communications of your health information by alternative means or at alternative locations as provided by 45 CFR, 164.522(b)
- Revoke your authorization to use or disclose health information except to the extent that action has already taken place as provided by 45 CFR, 164.508(b)(S)
Our Responsibilities
This organization is required to:
- Maintain the privacy of your health information
- Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate health information
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will keep a posted copy of the most current notice in our facility containing the effective date, as well as on our website. In addition, each time you visit our facility for treatment, you may obtain a copy of the current notice in effect upon request.
For More Information or to Report a Problem:
If you have any questions and would like additional information, you may contact Carole Rumberger at 518.980.9810 x3. If you believe your privacy rights have been violated, you can file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with us or the Office of Civil Rights.
Office of Civil Rights
U.S. Department of Health and Human Services
26 Federal Plaza Suite 3312
New York, NY 10278
Notice of Privacy Practices, 12/04/2022