This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Understanding Your Health Records/Information
Each time you visit a hospital, doctor or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment
- Means of communication among the many health professionals who contribute to your care
- Legal document describing the care you received
- Means by which your or a third-party payer can verify that services billed were actually provided
- A tool in educating health professionals
- A source of data for medical research
- A source of information for public health officials charged with improving the health of the nation
- A source of data for facility planning and marketing
- A tool with which we can look at and work to improve the care we give you and the outcomes we achieve
Who Will Follow this Notice?
This notice describes our clinic’s practices along with:
- Any healthcare professional authorized to enter information into your clinic record
- All departments of this clinic
- All co-workers
Acknowledgement of Receipt of This Notice
You will be asked to sign an acknowledgment of HIPAA practices when you come in for your first visit to our clinic. Each new year, you will be required to sign the acknowledgment again. Our purpose is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights.
Oklahoma Pain Center is required to:
- Keep your health information private
- Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- Follow the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Permit reasonable requests you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will make new copies available immediately.
We will not release your health information without your authorization, except as described in this notice.
Your Health Information Rights
Although your health record is the physical property of Oklahoma Pain Center, the information belongs to you. You have the right to:
- Inspect and obtain a copy- You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records compiled in reasonable anticipation of, or for use in civil criminal or administrative proceedings, or information subject to law that prohibits your access to such information.To inspect and obtain a copy of medical information that may be used to make decisions about you, you must sign a medical information release form. Once we receive the signed form, we will print the medical records and have them waiting for you at the front desk within fourteen business days.
- Right to an accounting of disclosures- You have the right to request an “accounting of disclosure.” This is a list of the disclosures of medical information we made about you. This excludes disclosures we may have made to you and disclosures for payment, treatment, and healthcare operations. This also excludes disclosures made according to your written authorization, disclosures of facility directory information or disclosures to family members and friends involved in your care, for notification purposes, for national security purposes, and disclosures of limited data sets which do not directly identify you. To request this list of accounting disclosures, you must make your request in writing to the office manager. Your request must state a time frame that may not be longer than six years. The request will be at eh front desk within two weeks of your request. The first list you request within a 12-month period will be free. For additional lists, we will charge you $10 per accounting.
- Right to request restrictions- You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will obey your request unless the information is needed to provide you emergency treatment. In your request, please tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
- Right to request confidential communications- You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
If you have any questions or would like more information, you may contact the Oklahoma Pain Center Office Manager at (405) 752-9600.
If you believe your privacy rights have been violated, you can file a complaint with the MHSO Compliance/Privacy Officer or with the office for Civil Right, Region VI, US Department of Health and Human Services, at:
1301 Young St.
Dallas, TX 75202
You will not be penalized for filing a complaint.