Privacy Statement
HOMEDEQ, INC
NOTICE: PATIENT PRIVACY
Date: April 14, 2003
We are committed to preserving the privacy of your personal health information. In fact, we are required by law to protect the privacy of your medical information and to provide you with Notice describing:
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.
We may be required or permitted by certain laws to use and disclose your medical information for other purposes without your consent or authorization. As our patient, you have important rights relating to inspecting and copying your medical information that we maintain, amending or correcting that information, obtaining an accounting of our disclosures of your medical information, requesting that we communicate with you confidentially, requesting that we restrict certain uses and disclosures of your health information, and complaining if you think your rights have been violated.
We have available a detailed Notice of Privacy Practices which fully explains your rights and our obligations under the law. We may revise our Notice from time to time. The effective date at the top right hand side of this page indicates the date of the most current Notice in effect.
You have the right to receive a copy of our most current Notice in effect. If you have not yet reserved a copy of our current Notice, please call our local office or refer to our website (www.homedeq.com) and we will provide you with a copy.
If you have any questions, concerns or complaints about the Notice or your medical information, please contact Rodger Kennedy or Leah Kennedy of our office at 713-748-6225.
Acknowledgement of Receipt of Notice of Privacy Practices
I certify that I have received a copy of Notice of Privacy Practices. The Notice of Privacy Practices describes the types of uses and disclosures of my protected health information that might occur in my treatment, payment of my bills or in the performance of health care operations.The Notice of Privacy Practices also describes my rights and HOMEDEQ's duties with respect to my protected health information. The Notice of Privacy Practices is posted in (location in the office where NPP is posted) and on HOMEDEQ's website at (www.homedeq.com).
HOMEDEQ reserves the right to change the privacy practices that are described in the Notice of Privacy Practices.I may obtain a revised Notice of Privacy Practices by calling the office and requesting a revised copy be sent in the mail, asking for one at the time of my next appointment, or accessing HOMEDEQ's website.
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Signature of Patient or Personal Representative
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Name of Patient or Personal Representative
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Date