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Ablaze, Inc. Notice of Privacy Practices
IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMAITON. PLEASE REVIEW IT CAREFULLY.
Every patient has the right to know what we do with the Protected Health Information (PHI) that we gather in the course of handling the billing for providers of medical services. We want to assure you that we properly safeguard this information as required by the Health Insurance Portability and Accountability Act (HIPAA), passed by Congress in 1996.
Definition of PHI:
Protected Health Information (PHI) includes information about a patient such as name, address, date of birth, telephone, health insurance identification number, and any other identifier unique to the patient.
Our medical clients use PHI for the following reasons:
Treatment
In the course of providing services to you our clients collects personal and health information to assist them with providing you with excellent care. This information is shared with other health professionals such as physicians and hospitals, to whom our clients transfer your care and treatment to.
Payment: PHI is used to support claims submitted to insurance companies for payment.
We will share your PHI only with authorized employees, representatives and third parties, such as insurance companies, and other health care agencies involved in your care. We will not disclose any non-public personal information about you except as authorized by law, described in this privacy statement or as otherwise communicated to you.
We are authorized to use PHI without your consent, authorization, or permission in the following situations: emergencies, national defense and security, litigation, public health situations, and government oversight activities.
Disclosure of PHI for purposes other than those permitted by law, will only be made with your written authorization. Such action will not affect disclosures prior to the effective date of the withdrawal.
Patient's Rights: As a patient, you have a number of rights with respect to your PHI, including:
The right to access, copy, or inspect your PHI.
The right to amend your PHI.
The right to request of disclosure of your PHI for purposes other than treatment, payment, and internal uses. Such as internal quality assurance activities and training.
The right to request an accounting of your PHI.
The right to request that we restrict the uses and disclosures of your PHI to other health care providers and family.
The right to complain to us or to the Secretary of the United States Department of Health and human Services if you believe that your privacy rights have been violated.
Because we respect and share your concern for privacy, we will not provide your health information to anyone outside of our company or other then the medical provider who treated you, except as described above.
Should you have any questions, comments or complaints you may direct all inquiries to our privacy officer.
Privacy Officer Contact Information:
Privacy Officer
Ablaze, Inc.
P.O. Box 932
Thayne, WY 83127
hipaa@ablazemedical.com
307-883-4336
Effective Date of the Notice: April 14, 2003
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