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AFC Norwalk

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privacy of your Protected Health Information (PHI). This Notice describes how we will treat your PHI and how we may use and disclose law. We may your share PHI to your carry health out treatment, information payment for treatment, or health payment care operations and health and operations for other as purposes described that in are this permitted Notice. This or required Notice also by describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify services. you and that relates to your past, present or future physical or mental health or condition and related health care Uses and Disclosures of Protected Health Information: Your PHI may be used and disclosed by the physician, our office staff and others to pay outside your health of our care offices bills, that to support are involved the operation in your care of the and business, treatment and for any the other purpose use required of providing by law. health We care may services disclose to PHI you, to family members, close friends or others concerned with your care and treatment.

Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes physician the to whom coordination you have or been management referred or of are your receiving health treatment care with from a third to ensure party. that For the example, physician your has PHI the may necessary be provided information to a to diagnose or treat you.

Payment: your insurance Your company PHI will be to used obtain to authorization obtain payment and for payment your health for services care services. rendered. For We example, may contact we may the provide Guarantor PHI for to your visit in order to obtain payment.

Healthcare Operations: We may use or disclose your PHI in order to support our business activities. These activities include, but are employees. not limited In addition, to business we will associates, use a sign-in quality sheet assessment at the registration activities, internal desk where investigations, you will be performance asked to provide reviews, your and name training and insurance company. We may also call you by name in the waiting room when the physician is ready to see you. We may use or disclose your be of PHI interest to contact to you, you and to to remind check you on your of an treatment, appointment, progress, to notify and you satisfaction of test results, with our to services. inform you of health-related services that may We may use or disclose your PHI in the following situations without your authorization: As required by Law, for Public Health requirements, issues, Legal Communicable proceedings, Diseases, Law Enforcement, Health Oversight, Coroners, Funeral Abuse Directors, or Neglect, Organ Food Donation, and Preliminary Drug Administration Research Identification, Research with an IRB waiver, Criminal Activity, Military Activity, to avert a serious and imminent threat to a person Required or Uses the and public, Disclosures. National Security, Under the to law, comply we must with Worker’s make disclosures Compensation to you laws, and when Inmates, required Disaster by the Relief Secretary and of other the Department of Health and Human Services.

Other permitted and required uses and disclosures, such as for marketing or sale of your PHI to third parties, will be made only with your authorization. Once given, you may withdraw authorization at any time in writing delivered to the address given below.

You have the right to inspect and copy your protected health information. Under federal law, you may not inspect or copy psychotherapy notes, information compiled in anticipation of, or use in, a legal proceeding, and PHI that is otherwise prohibited.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part the address of your PHI given for below, the purposes and state of the treatment, specific payment restriction or requested health care and operations. to whom you Your want request the must restriction be in to writing, apply. delivered If you have to paid for your services in full and ask us not to disclose your visit to your insurance company, we will honor that request. We are not required your PHI, to it will agree not to be any restricted. other restriction You then that have you the may right request to use and another if we health believe care it is professional. in your best interest to permit use and disclosure of You have the right to receive confidential communications from us by alternative means or at an alternative location by notifying us in writing, delivered to the address given below.

You have the right to obtain a paper copy of this notice from us, upon request to the Clinic Manager or our Privacy Officer.

You have may the have right the to deliver right to a ask statement us to amend of disagreement your protected with health us at the information. address given If we deny below your and written we may request prepare for a amendment, rebuttal to your you statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. Your request reportable must breach. be in writing, delivered to the address given below. We are required to notify you if your unsecured PHI is involved in a You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. Or, you may file a or complaint by mail or by contacting Angela Murphy, our Privacy Officer at the following address or phone number: 607 Main Avenue, Norwalk, CT 06851, 203-845-9100. We will not retaliate against you for filing a complaint.

We reserve the right to change the terms of this notice. Any change will apply to all PHI that we maintain. We post our current policy at each location and on our website. All written requests must be delivered to the Clinic Manager or mailed to HIPAA Privacy Officer.

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