This notice takes effect on September 13, 2013 and remains in effect until FURTHER NOTIFICATION.
THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. MISSISSIPPI UROLOGY CLINIC, PLLC IS PERMITTED TO MAKE USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS.
- For treatment.
- For payment.
- For health care operations.
2. MISSISSIPPI UROLOGY CLINIC, PLLC IS PERMITTED OR REQUIRED, UNDER SPECIFIC CIRCUMSTANCES, TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION WITHOUT THE INDIVIDUAL'S WRITTEN AUTHORIZATION.
3. OTHER USES AND DISCLOSURES WILL BE MADE ONLY WITH THE INDIVIDUAL'S WRITTEN AUTHORIZATION, AND THE INDIVIDUAL MAY REVOKE SUCH AUTHORIZATION.
4. MISSISSIPPI UROLOGY CLINIC, PLLC INTENDS TO ENGAGE IN (N)ONE OR MORE OF THE FOLLOWING ACTIVITIES:
Mississippi Urology Clinic, PLLC may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient.
Mississippi Urology Clinic, PLLC may contact the individual/Patient to raise funds for Mississippi Urology Clinic, PLLC; or
5. THE INDIVIDUAL HAS THE FOLLOWING RIGHTS REGARDING PROTECTED HEALTH INFORMATION:
- The right to request restrictions on certain uses and disclosures of their PHI; Mississippi Urology Clinic, PLLC is not required to agree to a requested restriction, however.
- The right to receive confidential communications of protected health information, as applicable.
- The right to inspect and copy protected health information, as provided in the Privacy Regulation. If they request a copy of the information, a reasonable fee to cover expenses associated with their request may be charged.
- The right to amend protected health information, as provided in the Privacy Regulation.
- The right to receive an accounting of disclosures of protected health information. An individual's request must specify a time period of up to six years and may not include dates prior to (effective date of this regulation).
- The right to receive notification in the event of a breach of unsecured protected health information.
- The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.
6. MISSISSIPPI UROLOGY CLINIC, PLLC IS REQUIRED BY LAW TO MAINTAIN THE PRIVACY OF PROTECTED HEALTH INFORMATION AND TO PROVIDE INDIVIDUALS WITH NOTICE OF ITS LEGAL DUTIES AND PRIVACY PRACTICES WITH RESPECT TO PROTECTED HEALTH INFORMATION.
7. MISSISSIPPI UROLOGY CLINIC, PLLC IS REQUIRED TO ABIDE BY THE TERMS OF THE NOTICE CURRENTLY IN EFFECT.
8. MISSISSIPPI UROLOGY CLINIC, PLLC RESERVES THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE. THE NEW NOTICE PROVISIONS WILL BE EFFECTIVE FOR ALL PROTECTED HEALTH INFORMATION THAT IT MAINTAINS.
9. MISSISSIPPI UROLOGY PLLC WILL PROVIDE INDIVIDUALS OR PATIENTS WITH A REVISED NOTICE.
10. INDIVIDUALS MAY COMPLAIN TO MISSISSIPPI UROLOGY CLINIC, PLLC AND TO THE SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, WITHOUT FEAR OF RETALIATION BY THE ORGANIZATION, IF THEY BELIEVE THEIR PRIVACY RIGHTS HAVE BEEN VIOLATED.
11. MISSISSIPPI UROLOGY CLINIC, PLLC'S CONTACT PERSON FOR MATTERS RELATING TO COMPLAINTS IS THE: PRACTICE ADMINISTRATOR
12. IF AN INDIVIDUAL WOULD LIKE THEIR COMPLAINT REVIEWED BY AN OUTSIDE AGENCY, THEY MAY CONTACT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AT THE FOLLOWING ADDRESS:
Department of Health and Human Services
The Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201