This notice describes how medical information about you may be disclosed and how you can get access to this information. Please review it carefully. It is our intent to protect your personal health care information from unauthorized release. It is, however, important to have your permission to release your health care information under certain circumstances. We want you to understand the uses and intentions of any release of this protected information. We also wish to have your permission to release information when it is required for your personal safety, benefit or for the public safety in cases of governmentally mandated reporting. We are listing here a comprehensive list of all the reasons, uses, intents, for such information release.
The medical providers at Workwell Occupational Medicine intend to release your personal, protected medical and health care information to others for the following purposes. We plan to release such information about you when medically necessary, when requested by you, when a medical provider or facility to whom we have referred you requires this information in order to properly treat you, when we are required to inform your insurance company of the financial billing information, diagnoses, and level of care in order to process a billing claim, and when such information is requested by your medical insurance carrier if you have given written permission for them to obtain it. On rare occasions it is necessary to provide information to regulatory agencies for quality assurance purposes and investigations and to Public Health agencies of state, country or federal governments to meet requirements as delineated by appropriate health care law or regulations.
We also want you to know that you have a right to inspect your medical records, to have a copy made (a nominal fee applies), and that you may request amendments or corrections be attached to the record, when requests are made in writing and signed by you or your legal guardian. You also have the right to request in writing restrictions on certain uses and disclosures of protected information (does not apply to government mandates), such as billing information for services which you do not want revealed and for which you are willing to pay separately. You also have the right to request in writing an accounting of all releases of protected health care information. You may revoke any previous consent for release of health care information in writing at any time.