Privacy Notice

Advanced Urology Institute - HIPAA 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.

This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition & related health care services.

Uses & Disclosures of Protected Health Information Your protected health information may be used and disclosed by your physician, our office staff and others outside our office that are involved with your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.

Treatment: We will use and disclose you PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your PHI, as necessary, to a home agency that provides care to you or a physician to whom you have been referred to ensure that the physician has the necessary information to diagnosis you.

Payment: Your PHI will be used, as needed, to obtain payment for your health care services.

Health Care Operations: We may use or disclose, as needed, your PHI in order to support business activities of your physician’s practice. These activities include, but not limited to, quality assessment activities, employee review activities, training of medical students, licensing, etc. We may also call you by name in the waiting room when your physician is ready to see you. We may also use your PHI in the following situations without your authorization. These situations include: as Required by Law, Public Health Issues required by Law, Communicable Diseases, Health Oversight, Abuse or Neglect, FDA requirements, Legal Proceedings, Law Enforcement, Workman’s Compensation, etc.

Other Permitted & Required Uses and Disclosures: Will be made ONLY with your consent, authorization unless required by law.

You may revoke this authorization at any time, in writing, except to the extent that your physician or the practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Your rights

You have the right to inspect & copy your PHI information. Under federal law however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment, or health care operations. You may also request that any or your entire PHI not be disclosed to any family member or friends not involved in your care or for notification purposes described in this notice of privacy practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may make. If your physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another Health Care Professional.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e. electronically.

You have the right to have your physician amend your PHI. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of you PHI. We reserve the right to change the terms of this agreement and inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.

Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filling a complaint.

This notice was published & becomes effective on/or before April 14, 2003. We are required by law to maintain the privacy of, and provide individuals with this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone. Your signature below is only acknowledgement that you have received this Notice of our Privacy Practices.