Effective Date: July 1, 2004

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

YOUR PRIVATE HEALTH INFORMATION (PHI)

Each time you have contact with a healthcare provider for delivery of healthcare, a record of your contact/visit is prepared. This record, maintained in written, oral or electronic format, contains presenting signs/symptoms, results of examination and tests, diagnoses, treatment and future care. Your medical record is the physical property of the office of ALEX W GARCIA, DPM, but you have certain rights to restrict some of the uses or disclosures of the information in your medical record. The office of ALEX W GARCIA, DPM, however, has the right to use and disclose the information contained in your medical record in the process of providing treatment, receiving payment and performing other regular health operations such as:

• Documenting and describing the care you received for legal purposes
• Communicating with other healthcare providers who may be involved in your care
• Educating health care professionals
• Medical research
• Providing information for government and public health entities responsible for improving public health and welfare
• Evaluating and improving the care you receive and the outcomes achieved
• Billing and verification of services provided to you
• Conducting other routine healthcare operations such as quality improvement studies and assessing healthcare provider competence

Protecting your privacy and maintaining the security of your health information is one of the most important responsibilities of the office of ALEX W GARCIA, DPM. The office of ALEX W GARCIA, DPM is required by law to maintain privacy and confidentiality of your health information, provide you with this Notice of Privacy Practices, notify you of your rights to restrict use of this information, notify you if the office of ALEX W GARCIA, DPM is unable to agree to a requested restriction, and allow you to review the Notice of Privacy Practices prior to granting consent and notifying you of changes/revisions to this Notice.

EXAMPLES OF DISCLOSURE OF YOUR PHI

• Healthcare delivery and treatment:
  Information obtained from you by a physician, nurse or other healthcare professional is documented in your record and used for the assessment, evaluation, diagnosis and treatment of your medical condition(s). This information is provided to other healthcare professionals, such as other physicians, specialists, physical therapists, hospital based providers and/or other healthcare providers following your treatment by the office of ALEX W GARCIA, DPM.
• Billing and payment:
  Your PHI is utilized to justify the level of care delivered to you and the charges incurred for the services. This information generally accompanies the bill and is sent to our payers.
• Other healthcare operations:
  The office of ALEX W GARCIA, DPM may disclose your PHI to other individuals and businesses in order for the office of ALEX W GARCIA, DPM to perform its day-to-day operations. These other individuals and businesses include business associates such as vendors and/or contractors used for billing and claims management, medical research, disease management, and quality improvement initiatives, as well as management services organizations, laboratories, other free standing diagnostic facilities and legal counsel. The office of ALEX W GARCIA, DPM requires all its business associates to agree to appropriately protect the confidentiality of your PHI.
• Reminders and Treatment:
  The office of ALEX W GARCIA, DPM may contact you to provide you with information that we feel is useful or helpful to you, based on your PHI. For example, the office of ALEX W GARCIA, DPM may contact you (or instruct a specialist physician to whom you have been referred to contact you) to schedule an appointment or as an appointment reminder, to suggest alternative treatments, or to provide you with information on treatments you are already receiving.
  
• Other Uses and Disclosures:
  The office of ALEX W GARCIA, DPM may also utilize or disclose your PHI in order to communicate with or notify family members, relatives and others responsible for your health, and funeral directors. In addition, the office of ALEX W GARCIA, DPM may disclose your PHI through other communications and reports required to be made by healthcare professionals such as the public health department, law enforcement, the Food and Drug Administration, organ procurement organizations, correctional institutions, and workers compensation, where applicable.
  

Other uses and disclosures of PHI not permitted or required by law will be made only with your written authorization. You may revoke your authorization at any time provided that the revocation is in writing, except to the extent that the office of ALEX W GARCIA, DPM has already taken action in reliance on your prior authorization.

YOUR RIGHTS CONCERNING PHI

Except as otherwise provided by law, you have the right to:

• Receive a paper copy of this Notice of Privacy Practices if you have agreed to receive it electronically.
  
• receive confidential communications of PHI if a request is submitted to the office of ALEX W GARCIA, DPM in writing;
• inspect and copy PHI or records about you in a designated record set as long as the PHI is maintained in the record set;
  
• ask the office of ALEX W GARCIA, DPM to amend PHI or records about you in a designated record set as long as the PHI or record is maintained in the record set (the office of ALEX W GARCIA, DPM is not required to change the information if it deems it to be accurate);
  
• receive an accounting of disclosures of PHI (a list of the disclosures made by the Office of ALEX W GARCIA, DPM about you for reasons other than treatment, payment or health care operations); and
  
• request that the office of ALEX W GARCIA, DPM restrict uses or disclosures of your PHI. Though the office of ALEX W GARCIA, DPM is not required to agree to a restriction, to the extent that it does agree with your request, the office of ALEX W GARCIA, DPM may not use or disclose the protected PHI in violation of the restriction unless the information is needed to provide emergency treatment, or is otherwise permitted or required by law.

The office of ALEX W GARCIA, DPM is required by law to abide by the terms of this Notice of Privacy Practices, allow you to review this Notice prior to granting consent, and notify you of changes/revisions to this Notice. If you believe your privacy rights have been violated, you may submit a written complaint to the office of ALEX W GARCIA, DPM or the Secretary of Health and Human Services describing in detail the manner in which you feel your privacy rights have been violated. The office of ALEX W GARCIA, DPM will not retaliate against you in any way for filing a complaint with the office of ALEX W GARCIA, DPM, or with the Secretary.

This Notice of Privacy Practices is effective as of July 1, 2004. For further information regarding PHI, please contact the office of Alex W Garcia, DPM, and Privacy Officer. (214) 492-1970.

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