This notice describes how health information about you may be
used and disclosed and how you may be used and disclosed and how you can get
access to this information. Please review it carefully.
NEEL RAYA MD Inc. is committed to providing you with high
quality health care and to forming a relationship with you that is built on
trust. That means respecting the privacy and confidentiality of your medical
information. We protect your privacy and confidentiality rights by creating and
putting into practice policies and procedures that allow access to your
personal medical information only for legitimate reasons. We ensure that
personal health information is protected during its collection, use,
disclosure, storage and destruction in the office of NEEL RAYA MD. We maintain
protocols to ensure the confidentiality of your personal information and access
to your information is limited to those who need it to perform their jobs for
your health care needs. This notice is effective April 14, 2003, and applies to
all protected health information as defined by federal regulations.
What is PHI – ‘Personal
Personal Health Information means all information, recorded or
exchanged verbally about an identifiable individual that relates to: the individual’s
health, or health care history, including genetic information about the
individual or the individual’s family. What NEEL RAYA MD has learned or
observed, including conduct or behavior that may be a result of illness or the
effect of treatment, the provision of health care to the individual.
Individuals include co-workers or families of co-workers when they are patients
of NEEL RAYA MD, for healthcare provided to the individual, and includes: the
personal health identification number and any other identifying number, symbol,
etc. assigned to an individual, any identifying information about the
individual that is collected in the course of, and is incidental to, the
provision of health care or payment for health care.
As we provide your health care, we are required to maintain a
complete copy of your medical history, current condition, treatment plan and
all treatment given, including the results of all tests, procedures and
therapies. Whether this information is stored in writing, on a computer, or
other means, we will keep this information in a safe and secure way that
protects your privacy and confidentiality. Typically this record contains your
symptoms, examination, test results, diagnosis, treatment, and a plan for
future care or treatment. This information serves as means of communication
among the many health professionals who contribute to your care. It is a legal
document describing the care you received. This document serves as a means by
which you or a third party payer can verify that services billed were actually
provided. This is a source of information for the public health officials
charged to improve the health of the state and nation.
YouR health information
Our office will make every effort to honor reasonable
restriction preferences from our patients, if it is made in writing
Right to request
restriction on certain uses and disclosures of your health information.
(However we are not required by law to agree to a requested restriction).
Right to request that we
communicate your health information in a certain way. You may request that we
only communicate your health information privately with no other family member
Right for a written
notice of information practices
Right for access to
read, review, and copy your health information, including your complete chart
and billing records. We may need to charge you a reasonable fee to duplicate
and assemble your copy.
Right to receive an
accounting of disclosures
Right to ask us to
update or modify your medical records if you believe your health information
records are incorrect or incomplete. We will be happy to accommodate you as
long as our office maintains this information. We will need the request in
writing and the reason for the change. Your request may be denied if the health
information record in question was not created in this office, is not part of
our records or if the records containing your health information are determined
to be accurate and complete.
Right to ask us for a description
of how and where your health information was used by our office for any reason
other than for treatment, payment, or health operations. Our documentation will
enable us to provide information on health information usage from April 14,
2003 and forward. Please let us know in writing the time period for which you
are interested. We may need to charge you a reasonable fee for this.
Right to timeliness of
access to records.
Right to expect
respectful care and as much information about their condition as possible.
Right to obtain a copy
of this Notice of Privacy Practices directly from our office at any time.
Our Practice is required to:
Maintain the privacy of
your health information.
Provide you with this notice
as to our legal duties and privacy practices with respect to information we
collect and maintain about you.
Abide by the terms of
Notify you if we are
unable to agree to a requested restriction, and
requests you may have to communicate your health information.
We reserve the right to
change our practices and to make the new provisions effective for all protected
health information we maintain. We will keep a posted copy of the most current
notice in our office containing the effective date. You may obtain a copy of
the same upon request.
We will not use or
disclose your health information in a manner other than described in this
notice without your written authorization, which you may revoke, except to the
extent that action has already been taken.
How the health
information may be used
To provide treatment,
for administrative and clinical office procedures.
To obtain payment for
We may be required by
law to provide health information to coroners, funeral directors and medical
examiners for the purposes of determining a cause of death and preparing for
We may disclose health
information to workers compensation to the extent authorized by and necessary
to comply with laws.
We do have an appointment
reminder system called MEDVOICE which automatically calls the home phone number
listed under your name to remind you about your next day's appointment with Dr.Raya, if you wish not to be reminded you will need to
make a written request and once that has been accepted you will be responsible
for missed appointments.
We may share some
information with our business associates such as professionals in emergency
room, radiology, laboratory department, transcription service, billing agency
this would be necessary to perform the jobs we have requested of them in caring
for you. We require these services to appropriately safeguard your information.
During audits by your
insurance company your health information may be reviewed. Government appointed
agencies may also audit the health information for quality assurance and
We will notify
government authorities if we believe a patient is the victim of abuse, neglect,
or domestic violence. We will make this disclosure only when we believe we are
specifically required or authorized by law or with the patient’s agreement.
We may be required to
disclose to federal officials or military authorities health information
necessary to complete an investigation related to public health or national
As permitted or required
by State or Federal law, we may disclose your health information to a law
enforcement official for certain law enforcement purposes.
We may share your health
information with your family members and others you tell us will be helping you
with your home hygiene, treatment, medications, or payment. If you do not want
us to share your information you must make a written request about the same and
also let us know whom we can contact in case we are unable to get hold of you.
In the case of an emergency, where you are unable to tell us what you want, we
will use our best judgment when sharing your health information.
OTHER THAN WHAT IS STATED ABOVE OR WHERE FEDERAL, STATE OR LOCAL
LAW REQUIRES US, WE WILL NOT DISCLOSE YOUR HEALTH INFORMATION OTHER THAN WITH
YOUR WRITTEN AUTHORIZATION. YOU MAY REVOKE THAT AUTHORIZATION IN WRITING AT ANY
Questions or complaints
If you have questions about the privacy of your medical records,
please contact Dr.Raya at 740-6546596.
If you believe your privacy rights have been compromised you
have the right to express complaints to Dr.Raya or to
the Secretary of Human and Health Services. We encourage you to express any
concerns you may have regarding the privacy of your information.
Please let us know of your questions or complaints in writing.