Lynnae Williams Medfile 2

8/11/2019 Lynnae Williams Medfile 2

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O ICE OFRIVACY PRAC ICEG IT VITZM D

THIS NOTICE DESCRIBES HOW MEDICAL I FORMATION A BOUT YOU MAY BE USED AND DISCLOSED ANDHOW YOU CA GET ACCESS TO THIS INFORMATIO N. PLEASE REVIEW IT CAREFULLY

h not ce t ke e ect on

14 2 3nd em n n e ectnt we e cet

1 OUR PLEDGE REGARDING MEDICAL INFORMA IONhe v cy o yo med c n o m t on m o t nt to We nde t nd th t you med c n o m t on nd we e comm tted to otect ng t We c e te eco do thec e nd e v ce you ece ve t ou ct

need th eco d to ov de you w th qu ty c e nd to com y w th ce n eg equ ementbou he w y we m y u e nd h e med c n o m on bo t you We o de c be yo

we h ve eg d ng the u e nd d c o e o med c n o m t on

2 OUR LEGAL DUTYLaw R quires Us to:Kee you med c n o m t on v te2 veyou th not ce de c b ng o eg l d t e , v cy ct ce , nd you g t eg

n o m t ono ow the te m o the not ce th t now n e ect

e Have the Right to:h ngeo v cy ct ce nd the te m o th not ce t ny t me ov ded th t the chby l w

ke the ch nge n ou v cy ct ce nd the new te m o o not ce e ect ve o med c n oth twe kee , nclud ng n o m t on ev o y c e tedo ece ved be o e the ch nge

Notice of Change to Privacy Practices1 Be o e e m ke n m o t nt ch nge n o v cy ct ce we w l ch nge th not ce

not ce v ble on eque t

3 SE AND DISCLOS E OF YOUR MEDICAL INFORMATIONhe o low ng ect on de c be d e ent w y th t we u e nd d clo e med c l n o m t on

d c o u e w be ted ou ec c w en utho z t onw be eque ted ou e o d c o u e o e nony ec c w tten tho z t on yo ov de m y be evoked t ny t me b w t ng to

FOR TREAT ENTWe m y u e med c n o m t on bout yo to ov de yo w th med c t e tme v ceWe m y d clo e med c l n o m t on bo t you to docto ,nu e ,techn c n med c tudent , o othe

e t k ng c e o yo We m y l o h e med c n o m t on bout you to you othe he lth hem n t e t ng yo

FOR EA T ARE O ERAT ONS:We m y e nd d c o e you med c n o m t on o ou heo e t on h m ght nc de me u ng nd m v ng qu ty ev lu t ng the e o m nt n ng og m nd gett ng the cc ed t t on, ce c te , cen e nd c edent we ne

ADD T ONASES AND D S OS S:n dd t on to u ng nd d clo ngyou med c n o m t on oyment, nd he th c e o e t on we m y u e nd d c o e e c n o t on o the ol

N tification ed c n o m t on to not y o he not y m ly membe yo e on ee on e on b e o yo c e We w h e n o m t on bo tyou oc t on gene cond t on o de

e n o m t on th t d ect y el te to th t e on nvo vement n yo he th c e yy e m on o ble be o e we h e o g ve yo t e o o un ty to e e e m

nd you e not ble to g ve o e u e e m on, we w l h e on y the he th n o t ono you he l h c e, cco d ng to ou o e on dgement We w o u e o o e

dec on n yo be t nte e t bout ow ng omeone to ck med c ne med c l l e , x- y o medn o m t on o yo

Disaster Rel ef: ed c n o m t on w th ubl c o v te o g n z t on o e on who c n eel e e oesearch n Limited Circumstances ed c n o m t on o e e ch u o e n m ted c ce e ch h been oved by ev ew bo d th t h ev ewed the e e ch o o nd e t

en e the v cy o med c n o m t on


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O ICE OPRIACYPRAC ICE F e D c o , o o e Me ic x i e o he p themca y'out theirdut es, wemay sha e the med lin ormat ono personwho has d edwit a co oner, med c ex miner, unera d rector,or an o gan pro rement

rganizat onSpeci ze o e e F c io s Subject to e ta nrequ rements we may d s ose o use hea th n ormam l ta y pe sonne andvete ans, ornationa secu ityand inte igen eactivities o p otect ve se ices or the rand othe s, or medica suitabi i y dete minat ons o the Dep ment o State or co e tiona nstitutions and oten orcement stod situations and o gove ment p og amsovid ng pub i bene its.

o O e s J ici d A i is i e ocee i s We m y dis ose med ca n ormat on in espa co t o dm nist at ve o der, subpoena, dis ove y equestor othe l w l pro ess under ce a n r mst

nder im ted c r umstancess ch as a cour o der, war nt,o g and y subpoena, we maysha e you medicain ormation w th aw en orcement of c a sWe may sha e m ted in orm tion with a aw en o ement o i

on e nng the medi al in o mation o an inmate o othe personn aw u ustody w th a w en o ement oorre t on institut on under ce ain rcumstances

b ic He h Ac i i ies s equ ed by law, we may d sc ose you medi a nfo mation to p b i heat or t es h rged w th revent ng or ontro l ing disease n ry, or d s bi l ty, n d ng h ld

m y lso d s ose yo r med al n ormat on to pe sons sub e t to r sd ct on o t e ood nd Drugr oses o re o ng dverse events sso ted w th prod t de e ts or prob ems, to enable p odu t re

re cements, to t a k rod ts or to ond ct act v t es requ red by the ood and Drug min strationw enwe re thor zed by law to do so, not y pe son whom y have been exposed toa commun ab e dise se oot erw se be at r sk o ontra t ng o spread ng dise se o ond tionVic s o se Ne ec o Do es ic Vio e ceWe may d sc ose med n orm t on to pp op i te we re son bly bel eve t t yo re poss ble v t m o ab se, neg e t, or domest c v o en e or the pot er r mes We m y sh e yo r med a n ormat on t s ne essary to prevent a se o s threats ety or t e he lth or sa ety o ot ers We m y sh remed l n ormat on when ne es ry to he p l w en oo ls t re person w o s dm tted to be ng p r o a cr e o h s es ped rom lega Wo ke s Co pe s io We m y dis lose he t n ormat on w en thor zed and necessa y to om lyrel t ng to workers om ensation or other s m a programsHe h O e sigh Ac i i iesWe m y d sc ose med n ormat on to n gency rov d ng healt overo ers g t tiv t es a t or zed by l w, n l d ng d ts c vil, adm n strat ve, or r min nves

ns e t ons ens re or d s pl n ry t ons, o r other t or zed tiv t esLaw nfo ce en nder e a n r st n es, we may d s ose health n ormation to law en orce ent

ese r mst n es n l de re ort ng req red by ert n ws (s ch as the re o t ng o ert in typrs nt to e n s b oen s or o r orders, report ng m ted n orm tion con erning denti ati

t e req est o w en or ement o c , reports regard ng s s ected vict ms o mes at he eq esen or ement o , re o ng de th, rimes on o r rem ses, and r mes n emergen ies

4 YO R INDIVIDU L RIGH Sou H e i h o

ook t or get o es o yo med l n orm tion s r g t does not app y to psychot erapy nm ke req est n wr t ng nd there s harge or opy ng nd m i ng e ords e se ask o o r ee s r t re

2 e e ve st o al the t mes we shared yo r med al n orm t on or p r oses other than treatme lt e o er t ons nd ot e s e i ed exce t onseq est th t we la e add t on l restr t ons on o r use or d s os re o yo r med n orm ti

req red to agree to these dd t on l rest t ons, b t i we do so, we wi l b de by our greement se o an emergen y)

4 eq est that we omm n te w th yo about yo r med al n orm tion by di erent me ns o to io rreq est th t we comm n ate yo r med c l in orm tion to yo by d erent me ns or t d er

m st be made n writ ng to yo r do toreq est that we nge your med al in ormat on We m y deny yo req est we d d not c eateyo w nt nged or or e t n othe re sons we deny yo r req est, we w l p ov de yo

o m y res ond w t statement o d s greement th t wi l be added to the n or t on yo w nt e tyo r req est to nge the n orm t on, we w make re son ble e orts to te l others, n

n me,o the h nge nd to n de t e hanges n any t re s r ng n orm t o

Q S ONS ND COM L IN Syo h ve ny q est ons bo t t s not ce or yo t nk t twe m y ve o ted yo r pr v y ghts les o may lso s bm t wr tten om int to the e rtment o e t nd man erv es We w

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13/28

THANK OU O ALLOW NG US TO SE E OU

Listed below are de nitions to hel describe this Ex lanation of Bene ts.

P OV DE : The hospital, e h car i l ty phys an or other eal h are p o es s op o ded erv e to you

PROVIDE R PE Each local Blue n B e S el lan can cont a t ith p o i en ts e ce area. There are two ypes o o e ional contra t ng pro der Pre rre

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Lynnae Williams Medfile 2

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