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.
Merivane Private Medicine is required by the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy of your health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
For treatment
We use your health information to provide your care and share it with other professionals involved in your care, such as specialists, hospitals, laboratories and pharmacies.
For payment
We may use and disclose your information to bill and receive payment for services, including from your health plan where services are covered.
For health care operations
We may use your information to run our practice, improve quality of care, train staff and meet legal requirements.
Family and friends involved in your care
With your written permission, or if you do not object when given the chance, we may share relevant information with a family member or friend involved in your care. You decide who we speak with and what we share, and you can change or withdraw this at any time.
Other uses permitted or required by law
- When required by federal, state or local law
- For public health activities, such as reporting certain diseases
- To prevent a serious threat to health or safety
- For health oversight activities, such as audits and inspections
- In response to a valid court order or legal process
- To coroners, medical examiners and funeral directors as permitted by law
- For workers compensation as authorized by law
Uses that require your written authorization
We will not use or disclose your health information for marketing purposes, sell your health information, or share psychotherapy notes without your written authorization. Any other use not described in this notice will be made only with your written authorization, which you may revoke in writing at any time.
Your rights
- Get a copy of your records. You may ask for an electronic or paper copy of your medical record. We will usually provide it within 30 days and may charge a reasonable, cost based fee.
- Ask us to correct your record. You may ask us to correct information you believe is incorrect or incomplete.
- Request confidential communications. You may ask us to contact you in a specific way or at a specific address.
- Ask us to limit what we use or share. You may ask us not to use or share certain information. If you pay for a service in full out of pocket, you may ask us not to share it with your health plan.
- Get a list of disclosures. You may ask for a list of the times we have shared your information in the past six years, with certain exceptions.
- Get a copy of this notice. You may ask for a paper copy at any time.
- Choose someone to act for you. A person with medical power of attorney or a legal guardian may exercise your rights.
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights. We will never retaliate against you for filing a complaint.
Changes to this notice
We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.
Privacy Officer
Merivane Private Medicine
Attn: Privacy Officer
1180 Westlake Hollow Drive, Suite 210
Austin, TX 78746
Phone: (512) 555 0187
Email: care@merivanemedicine.com