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.
Our Pledge
Bluetail Medical Group is required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with this notice describing 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
[Describe how PHI is used for treatment: sharing with other providers, specialists, labs, pharmacies, and others involved in your care.]
For Payment
[Describe how PHI is used for payment: billing, insurance claims, eligibility checks, collection activities.]
For Healthcare Operations
[Describe how PHI is used for operations: quality improvement, staff training, accreditation, legal services, business management.]
Other Permitted Uses and Disclosures
[Describe uses permitted by law without authorization: public health activities, abuse or neglect reporting, FDA-regulated products, judicial proceedings, law enforcement, organ procurement, military, workers' compensation, research with IRB approval, threats to safety, specialized government functions.]
Uses Requiring Your Authorization
Uses and disclosures of PHI not described above will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already relied on it. Most uses of psychotherapy notes, marketing communications, and sale of PHI require your authorization.
Your Rights
Right to Inspect and Copy
[Describe the right to inspect and obtain a copy of PHI in the designated record set, including in electronic form where applicable. Note any fees and response timelines.]
Right to Amend
[Describe the right to request amendment of PHI you believe is incorrect or incomplete. Note our right to deny under certain conditions.]
Right to an Accounting of Disclosures
[Describe the right to request a list of certain disclosures we have made of your PHI.]
Right to Request Restrictions
[Describe the right to request limits on the PHI we use or disclose. Note that we are required to honor a request to restrict disclosure to a health plan for items paid in full out of pocket.]
Right to Confidential Communications
[Describe the right to ask that we communicate with you about medical matters in a certain way or at a certain location.]
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice on request, even if you have agreed to receive it electronically. Please contact us to request a paper copy.
Our Responsibilities
We are required by law to maintain the privacy of your PHI, give you notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect. We will notify you if a breach occurs that may have compromised the privacy or security of your information.
Changes to This Notice
We reserve the right to change this notice and to make the revised notice effective for PHI we already have, as well as information we receive in the future. The current notice will be posted in our facilities and on this website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Contact
To exercise any of these rights or to ask questions about this notice, please contact our Privacy Officer.