This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Falls Church Osteopathic Medicine, LLC does not participate with any third party carriers and does no electronic billing, therefore our patients have virtually no risk for their medical records to become part of the public healthcare data bank. We will do everything that we can to protect your privacy.
According to HIPPA, effective April 2003, the following guidelines are to become policy at Falls Church Osteopathic Medicine, LLC to fall within the purview of the law.
When health care information can be used or disclosed without prior authorization:
There are certain situations where Falls Church Osteopathic Medicine, LLC may be forced to release some of your private medical information without your prior authorization, such as the following:
- When our office receives a written request/subpoena from any law enforcement agency or representative. Our office is under legal obligation to provide the subpoenaed materials to the requesting authority.
- If your physician refers you to another physician/ specialist for further medical evaluation and treatment, we will share information deemed necessary for your medical treatment.
- Falls Church Osteopathic Medicine, LLC will only share the necessary information from your patient medical records with the pharmacy for prescriptions written by our physicians.
- Falls Church Osteopathic Medicine, LLC has the right to share any and all medical information with third party carriers of all of our workman’s compensation or other similar programs in the interest of seeking financial reimbursement. Any information other than what is needed for financial reimbursement will not be shared.
- Falls Church Osteopathic Medicine, LLC will disclose your health information if there is a risk to the public health.
- Falls Church Osteopathic Medicine, LLC will disclose your health information in cases of domestic violence.
- Falls Church Osteopathic Medicine, LLC will disclose your health information to a coroner or medical examiner or funeral director so they may carry out their official duties.
- Except for the above listed circumstances, Falls Church Osteopathic Medicine, LLC will not use or disclose your health information without first notifying you and obtaining your written permission to do so.
All patients have the following rights:
- Right to request certain restrictions on the release of your medical information. If you desire to maintain a certain restriction, please ask for a wavier form and it will be added to your medical chart. Falls Church Osteopathic Medicine, LLC has the right not to agree to this waiver.
- Right to confidential communication between your doctor and yourself.
- Right to view and obtain a copy of your medical chart and/or billing records. Falls Church Osteopathic Medicine, LLC retains the right to charge a modest fee to cover the expense of copying these records.
- Right to amend your health care information if you believe it is incorrect or incomplete. A request to amend your records must be made in writing and describe the reasons why such an amendment is being requested. This right extends only to the records created by and that are a part of your medical chart in this office. Falls Church Osteopathic Medicine, LLC retains the right to deny your request for amending your records. This denial will be provided to you in writing.
- You have the right to request an accounting of all of the disclosures of your records made by Falls Church Osteopathic Medicine, LLC for any reason other than treatment/referral or payment reimbursement made within the past six years. This request must be made in writing.
- You have the right to receive a paper copy of the notice of Privacy Practices at any time, even if you have received it previously or have viewed it previously.
Falls Church Osteopathic Medicine, LLC
313 Park Avenue, Suite G-9
Falls Church, Virginia 22046
Portions of this document were taken from:
Medical Office Manager, Volume XVII, number 3, March 2003
The Sendi Center for Cosmetic Surgery, Inc.
Family Medicine of Clifton/Centreville