ࡱ> 463 bjbj 4   h|~~~~~~$eF,,,"|,|,,,y.,h0,M,M,,M@(,,M : This notice describes how your personal medical information may be used & how you can gain access to this information. PLEASE READ THIS INFORMATION CAREFULLY & DIRECT ANY QUESTIONS TO A MEMBER OF THE BLUE RIDGE WOMENS HEALTH CENTER STAFF. _______________________________________________________ NOTICE OF INFORMATION PRACTICES 1. Blue Ridge Women's Health Center, P.L.C. may use & disclose protected patient health information for treatment, payment, & healthcare operations. Examples of treatment information include, but are not limited to, requested physical examination forms, referrals to other physicians, health care providers, &/ or home health agencies. Payment examples include, but are not limited to, insurance companies claim filing &/or coordination of benefits with other insurers or collection agencies. Healthcare operations include, but are not limited to internal quality control & assurance including auditing of records. 2. Blue Ridge Women's Health Center, P.L.C. is permitted or required to use or disclose protected health information without the patients written consent or authorization in certain circumstances. Two examples of such are for public health requirements or court orders. Patients will always be notified in these circumstances. 3. Blue Ridge Women's Health Center, P.L.C. will not make any other use or disclosure of a patients protected health information without the patients written authorization. Such authorization may be revoked at any time. Revocation must be written. 4. Blue Ridge Women's Health Center, P.L.C. may at times contact the patient to provide appointment reminders or give information regarding treatment recommendations or other health-related services that may be of interest to the individual patient. All patients will be given a Consent to Contact form specifying how the patient desires to be reached. Options regarding telephone, mail, e-mail & voice messaging will be given. 5. Blue Ridge Women's Health Center, P.L.C. will abide by the terms of this notice or the notice currently in effect at the time of disclosure. 6. Blue Ridge Women's Health Center, P.L.C. reserves the right to change the terms of its notice & to make new notice provisions effective for all protected health information that it maintains. 7. Blue Ridge Women's Health Center, P.L.C. will provide each patient with a copy of any revision of its Notice of Information Practices at the time of their next visit, or at their last known address if there is need to use or disclose any patients protected health information. Copies may also be obtained at any time at the Center. 8. Any person/patient may file a complaint to Blue Ridge Women's Health Center, P.L.C. & to the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complain with the Center contact: Center Coordinator Blue Ridge Women's Health Center, P.L.C. 1885 Port Republic Road Harrisonburg, VA 22801 540-433-6613 All complaints will be investigated & the results reported to the Director as well as to the complainant. 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