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.
1. Purpose
I understand that medical information about you and your health is personal and I am committed to protecting that information. I create a record of the care and services that you receive from me in order to provide you with quality care and to comply with certain legal requirements.
This Notice of Privacy Practices describes how I may use and disclose medical information about you, including demographic information that may identify you and your related health care services, to carry out your treatment, to obtain payment for my services, to perform the daily health care operations of practice and for other purposes that are permitted or required by law. This notice also describes your rights to access and control of your medical information. I am required to abide by the terms of this Notice of Privacy Practices.
2. Written Acknowledgement
You will be asked to sign a written statement acknowledging that you have received a copy of this Notice. The acknowledgement only serves to create a record that you have received a copy of the Notice.
3. Changes to this Notice
I may change the terms of my Notice, at any time. The new Notice will be effective for all medical information that I maintain at that time. Upon your request, I will provide you with any revised Notice of Privacy Practices. To request a revised copy, you may call my office and request that a revised copy be sent to you in the mail or you may ask for one at the time of your next appointment.
4. How I May Use and Disclose Medical Information About You
The following categories describe the different ways that I may use and disclose your medical information and a few examples of what I mean. These examples are not meant to describe every circumstance, but to give you an idea of the types of uses and disclosures that may be made by my office. Other uses and disclosures of your medical information that are not listed or described below will be made only with your written authorization. You may revoke this authorization at any time, in writing, but it will not apply to any actions I have already taken.
For your treatment: Your medical information may be used and disclosed by me for the purpose of providing medical treatment to you or for another health care provider who is providing medical treatment to you. For example, a nurse obtains treatment information about you and documents it in your medical record and the physician has access to that information. If you require an x-ray to be taken, the x-ray technician also has access to your medical information. In addition, your medical information may be provided to a physician to whom you have been referred or are otherwise seeing, to ensure that the physician has the necessary information to diagnose or treat you.
To obtain payment for my services: Your medical information may be used and disclosed by me to obtain payment for your health care bills or to assist another health care provider in obtaining payment for their health care bills. For example, I may someday submit requests for payment to your health insurance company for the medical services that you received. I may also disclose your medical information as required by your health insurance plan before it approves or pays for the health care services that I recommend for you. (cont’d on page Two)
Dr. Pamela K. Hannaman, M.S., N.D., C.P.C.
WA State Licensed, Board Certified Naturopathic Physician
Master of Science Biochemistry • Certified Professional (Medical) Coder
13074 Fairway Lane, Ashland, VA 23005 • H.Office (804) 798-4133 • FAX (804) 752-4935 • Cell (804) 350-4152