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Notice of Privacy Practices - 5

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Your Health Information Rights

You have the right to:

Request a restriction on uses and disclosures of your health information: Except where we are required by law to disclose the information, you have the right to ask us not to use or disclose certain health information we maintain about you. ARHS is not required to agree to your request, with the exceptions described below. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions, complete a Request for Restriction of Protected Health Information form. In your request, you must 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, for example, disclosures to your spouse.

  • Long term care facility exception If you are a patient of our long term care facility, you have a right to have your health information withheld from persons involved in a licensing inspection. If you do not want information about you released to such individuals, let us know by completing a Request for Restriction of Protected Health Information form.
  • Request to not disclose health information to your health plan or insurance company You may request that we not disclose your health information to your health plan or insurance company for some or all of the services you receive during a visit to any ARI-IS location. If you pay the charges for those services you don't wish disclosed in flit! at the time of service, we generally are required to agree to your request unless the disclosure is for treatment purposes or is required by law. "In full" means the amount we charge for the service, not your copay, coinsurance, or deductible responsibility when your health plan or insurer pays for your care. There may be limitations on our ability to agree to your request, including, for example, if you want to restrict disclosure of only some of a group of items or services provided in a single visit where the group of services is typically bundled together for payment. Once information about a service has been submitted to your health plan or insurance company, we cannot agree to your request, so if you think you may wish to restrict the disclosure of your health information for a certain service, please let us know as early in your visit as possible by completing a Request for Restriction of Protected Health Information form.

Request to inspect and obtain a copy of your health record: Your health information is contained in records that are the physical property of ARHS. You have the right to request to inspect and obtain a copy of your health information and billing records. You also have the right to request that the copies be provided electronically on a disk. You may request that we send an electronic copy to any person or entity you designate in writing, and we will do so if you clearly identify the person or entity and where to send the information. To inspect, receive a copy, or have us send a copy of your health information to someone else, submit a request in writing to the Health Information Management Department. We may charge a fee for the costs associated with providing you or a third party paper or electronic copies of your records. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial.

Request to correct or amend information in your health record: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing to the Health Information Management Department that provides a reason supporting your request. If we determine that the health information is incorrect or incomplete, we will revise your record. If we deny your request, you may submit a written statement of disagreement and ask that it be included in your medical record.

Request confidential communications: You have the right to request that we communicate with you about health information in a certain way or at a location other than your home address. For example, you may ask that we contact you by mail rather than by telephone, or at work rather than at home. We will accommodate all reasonable requests and will not ask you the reason for your request. It is your responsibility to make sure we have your correct address and contact information.

Receive a listing of how your information has been shared, with some exceptions under the law: You have the right to request a listing of disclosures we have made of your health information for purposes other than treatment, payment and health care operations. Your request must be submitted in writing to the Health Information Management Department and must state the time period for which you want this listing, which may not be longer than six years before the date of your request.

Receive a paper copy of this notice: You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this notice at any time.