Patient Rights

Access:
You have the right to look at or get copies of your healthcare information, with limited exceptions. Unless you are requesting films, you must make a request in writing to obtain access to your healthcare information. You may request access by sending a letter or obtaining a form to request that we provide photocopies. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. If you request copies, we will charge you $0.75 for each page, $10.00 per hour for staff time to locate and copy your healthcare information, and postage if you want the copies mailed to you. If you require x-ray film copying there is a different fee schedule. Contact us using the information listed at the conclusion of this Notice for a full explanation of our fee schedule.

Disclosure Accounting:
You have the right to receive a list of instances in which we or our business associates disclosed your health information for a purpose other than treatment, payment, healthcare operations, and certain other activities, for the last 6 years, but not before April 14, 2003. We will respond within 60 days of receiving your request. 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.

Restrictions:
You have the right to request that we place additional restrictions on our use of, 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 Communications:
You have the right to request that we communicate with you about your healthcare information by alternative means or to alternate locations. (You must make your request in writing). Your request must specify the alternative means or location, and provide satisfactory explanation how healthcare information 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:
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.

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