THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, YOUR RIGHTS CONCERNING YOUR PERSONAL HEALTH INFORMATION AND OUR RESPONSIBILITIES TO PROTECT YOUR PERSONAL HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
Federal law requires PHP Management Group, LLC, dba Primary Health Partners (Private Practice) to make this Notice of Privacy Practices (“Notice”) available to all persons and to make a good faith effort to obtain a signed document acknowledging patients’ receipt of this Notice. If you have any questions about this notice, please call the Private Practice.
Primary Health Partners
When Is This Notice Effective?
This Notice became effective on October 1, 2015. We reserve the right to change this Notice after the effective date. We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice, if any, will be available upon request, in our office and on our website.
Private Practice Contact Information:
Primary Health Partners
Kyle Rickner, MD, Robert Lockwood, MD & Catrina Bourne, MD
1820 Commons Circle, Suite B
Yukon, OK 73099
Phone: (405) 265-2778
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we have shared your information
- Get a copy of this Notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated.
You have some choices in the way that we use and share information as we
- Tell family and friends about your condition
- Provide disaster relief
- Provide mental health care
- Market our services
Our Uses and Disclosure
We may use and share your information as we:
- Treat you
- Run our organization
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement and other government requests
- Respond to lawsuits and legal action
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete.
- If we deny your request, we will tell you the reason for denial in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send email to a different email address.
- We will comply with all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain information for treatment, payment or our operations. We are not required to agree to your request and we may deny your request if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment of our operations with your health insurer. We will honor your request unless we’re required by law to do otherwise.
Get a list of those with whom we have shared information
- You can request a list (accounting) of the times we have shared your health information for six years prior to the date of your request, who we shared it with and why.
- We will include all the disclosures except for those about treatment, payment and health care options along with other certain disclosures (such as any you asked us to make).
Get a copy of this Notice
- You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information on Page 1.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave, S. W. Washington, D.C. 20201 or calling 1-877-696-6775 or visiting www.hhs.gov/cor/privacy/hipaa/complaints/
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us your preference and we will comply with your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends or others involved in your care
- Share information in a disaster relief situation
If you are not able to tell us your preference, for example, you are unconscious, we may go ahead and share your information if we believe it’s in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In the following situations we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
Our Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways:
- We can use your health information and share it with other professionals who are treating you. For example, a doctor treating you for an injury may ask another doctor about your overall health condition
Run our organization
- We can use and share your health information to run our practice, improve your care and contact you when necessary. For example, we use your health information to manage your treatment and services
How else can we use or share your health information?
We are allowed or required to share your information in other ways- usually in ways that contribute to the public good such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medication
- Reporting suspected abuse, neglect or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- We can use or share your information for health research
Comply with the law
- We will share information about you if state or federal laws require it; including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law
Respond to organ and tissue donation requests
- We can share health information about you with organ procurement organizations
Work with a medical examiner or funeral director
- We can share health information with a coroner, medical examiner or funeral director when an individual dies
Address workers’ compensation, law enforcement and other government requests
We can use or share health information about you in these circumstances:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order or in response to a subpoena
- 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
- We must follow the duties and privacy practices described in this Notice and give you a copy of it
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time
For more information see: