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Our Legal Duty
We are required by applicable
federal and state law to maintain the privacy of your health
information. We are also required to give you this Notice
about our privacy practices, our legal duties, and your
rights concerning your health information. We must follow
the privacy practices that are described in this Notice
while it is in effect. This Notice takes effect April 1,
2003 and will remain in effect until we replace it.
We reserve the right to change
our privacy practices and the terms of this Notice at any
time, provided such changes are permitted by applicable law.
We reserve the right to make the changes in our privacy
practices and the new terms of our Notice effective for all
health information we maintain, including health information
we created or received before we made the changes. Before we
make a significant change in our privacy practices, we will
change this Notice and make the new Notice available upon
request.
You may request a copy of or Notice at any time. For more
information about our privacy practices, or for additional
copies of this Notice, please contact us using the
information at the end of this list.
Uses and
Disclosures of Health Information
We use and disclose health
information about you for treatment, payment, and health
care operations. For example:
Treatment: We may use or
disclose your health information to a physician or other
health care provider providing treatment to you.
Payment: We may use and
disclose your health care information to obtain payment for
services we provide to you.
Healthcare Operations:
We may use and disclose your health information in
connection with our healthcare operations. Healthcare
operations include quality assessment and improvement
activities, reviewing the competence or qualifications of
healthcare professionals, evaluating practitioner and
provider performance, conducting training programs,
accreditations, certification, licensing and credentialing
activities.
Your Authorization: In
addition to our use of your health information for
treatment, payment or healthcare operations, you may give us
written authorization to use your health information or to
disclose it to anyone for any purpose. If you give us an
authorization, you may revoke it in writing at any time.
Your revocation will not affect any use or disclosure
permitted by your authorization while it was in effect.
Unless you give us a written authorization, we cannot use or
disclose your health information for any reason except those
described in this Notice.
To Your Family and Friends:
We must disclose your health information to you, as
prescribed in the Patient Rights section of this Notice. We
may disclose your health information to a family member,
friend or other person to the extent necessary to help with
your healthcare or with payment for your healthcare, but
only if you agree that we may do so.
Persons Involved in Care:
We may use or disclose health information to notify, or
assist in the notification of (including indentifying or
locating) a family member, your personal representative, or
another person responsible for your healthcare, of your
location, your general condition, or death. If you are
present, then prior to use or disclosure of you health
information, we will provide you with an opportunity to
object to such uses or disclosures. In the event of your
incapacity or emergency circumstances, we will disclose
health information based on a determination using our
professional judgment disclosing only health information
that is directly relevant to the person’s involvement in
your healthcare. We will also use our professional judgment
and out experience with common practice to make reasonable
inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays, or
other similar forms of health information.
Marketing Health-Related
Services: We will not use your health information for
marketing communications without your written authorization.
Required by Law: We may
use or disclose your health information when we are required
to do so by law.
Abuse or Neglect: We may
disclose your health information to appropriate authorities
is we reasonably believe that you are a possible victim of
abuse, neglect, or domestic violence or the possible victim
of other crimes. We may disclose your health information to
the extent necessary to avert a serious threat to your
health or safety or the health or safety of others.
National Security: We
may disclose to military authorities the health information
of Armed Forces personnel under certain circumstances. We
may disclose to authorize federal officials health
information required for lawful intelligence, counter
intelligence, and other national security activities. We may
disclose to correctional institution or law enforcement
officials having lawful custody of protected health
information of inmate or patient under certain
circumstances.
Appointment Reminders:
We may use or disclose your health information to provide
you with appointment reminders (such as voicemail messages,
postcards or letters).
Patient Rights
Access: You have the
right to look at or get copies of your health information
with limited exceptions. You may request that we provide
copies in a format other than photocopies. We will use the
format you request unless we cannot practicably do so. (You
must make a request in writing to obtain access to your
health information. You may obtain a form to request access
by using the contact information listed at the end of this
Notice. We will charge you a reasonable cost-based fee for
expenses such as copies and staff time. You may also request
access by sending us a letter to the address at the end of
this Notice. If you request copies, we will charge you $20
to locate and copy your healthcare information, and postage
if you want the copies mailed to you. If you request an
alternative format, we will charge a cost-based fee for
providing your health information in that format. If you
prefer, we will prepare a summary or an explanation of your
health information for a fee. Contact us using the
information listed at the end of this Notice for a full
explanation of our fee structure.)
Disclosure Accounting:
You have the right to receive a list of instances in which
we or our business associates disclose your health
information for purposes other than treatment, payment,
healthcare operations and certain other activities, for the
last 6 years, but not before April 14, 2003. If you request
this accounting more than once in a 12 month period, we may
charge you a reasonable, cost-based fee for responding to
these additional requests.
Restriction: You have
the right to request that we place additional restrictions
on our use or disclosure of your health information. We are
not required to agree to these additional restrictions, but
if we do, we will abide by our agreement (except in an
emergency).
Alternative Communication:
You have the right to request that we communicate with you
about your health information by alternative means or to
alternative locations. {You must make your request in
writing.} Your request must specify the alternative means
or location, and provide satisfactory explanation how
payments will be handled under the alternative means or
location you request.
Amendment: You have the
right to request that we amend your health information.
(Your request must be in writing, and it must explain why
the information should be amended.) We may deny your request
under certain circumstances.
Electronic Notice: If
you receive this Notice on our Web site or by electronic
mail (e-mail), you are entitled to receive this Notice in
written form.
Questions and
Complaints
If you want more information
about our privacy practices or have questions or concerns,
please contact us.
If you are concerned that we ay
have violated your privacy rights, or you disagree with a
decision we made about access to your health information or
in response to a request you made to amend or restrict the
use or disclosure of your health information or to have us
communicate with you by alternative means or at alternative
locations, you may complain to us using the contact
information listed at the end of this Notice. You also may
submit a written complaint to the U.S. Department of Health
and Human Services. We will provide you with the address to
file your complaint with the U.S. Department of Health and
Human Services.
We support your right to the
privacy of your health information. We will not retaliate in
any way if you choose to file a complaint with us or with
the U.S. Department of Health and Human Services.
Contact: Privacy Officer
Telephone 865-977-7110 Fax: 865-977-4132
Address: 1858 Crest Road -
Maryville Tennessee 37804 |