DR. ELIZABETH WADE, LLC
PATIENT NOTICE OF PRIVACY PRACTICES
As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of
1996-(HIPAA), Health Information Technology for Economic and Clinic Health Act (HITECH Act), and associated
regulations and amendments
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice or if you need more information, please contact:
Dr Elizabeth Wade
Your Information. Your Rights. Our Responsibilities.
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.
ABOUT THIS NOTICE.
We understand that health information about you is personal and we are committed to protecting your information. We create a record of the care and services you receive from Dr Elizabeth Wade. We need this record to provide care (treatment), for payment of care provided, for health care operations, and to comply with certain legal requirements. This Notice will tell you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to follow the terms of this Notice that is currently in effect.
You have the right to:
● Get a copy of your health and claims records
● Correct your health and claims records
● Request confidential communication
● Ask us to limit the information we share
● Get a list of those with whom we’ve shared your information
● Get a copy of this privacy notice
● Choose someone to act for you
● File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
● Answer coverage questions from your family and friends
● Provide disaster relief
● Market our services and sell your information
Our Uses and Disclosures
We may use and share your information as we:
● Help manage the health care treatment you receive
● Run our organization
● Pay for your health services
● Administer your health plan
● Help with public health and safety issues
● Do research
● Comply with the law
● Respond to organ and tissue donation requests and work with a medical examiner or funeral director
● Address workers’ compensation, law enforcement, and other government requests
● Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get a copy of health and claims records
● You can ask to see or get a copy of your health and claims records and other health information we
have about you. Ask us how to do this.
● We will provide a copy or a summary of your health and claims records, usually within 30 days of your request.
We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
● You can ask us to correct your health and claims records if you think they are incorrect or incomplete.
Ask us how to do this.
● We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
● You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a
● We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
Ask us to limit what we use or share
● You can ask us not to use or share certain health information for treatment, payment, or our operations.
● We are not required to agree to your request, and we may say “no” if it would affect your care.
Get a list of those with whom we’ve shared information
● You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the
date you ask, who we shared it with, and why.
● We will include all the disclosures except for those about treatment, payment, and health care operations, and
certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but
will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
We will provide you with a paper copy promptly.
Choose someone to act for you
● If you have given someone medical power of attorney or if someone is your legal guardian, that person can
exercise your rights and make choices about your health information.
● We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
● You can complain if you feel we have violated your rights by contacting us using the information at the top of the page.
● You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by
sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or
● We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us.
Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
● Share information with your family, close friends, or others involved in payment for your care
● Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your
information if we believe it is in your best interest. We may also share your information when needed to lessen a serious
and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
● Marketing purposes
● Sale of your information
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional
Run our organization
● We can use and disclose your information to run our organization and contact you when necessary.
● We are not allowed to use genetic information to decide whether we will give you coverage and the price of
that coverage. This does not apply to long term care plans.
Example: We use health information about you to develop better services for you.
Pay for your health services
We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your health insurance plan to coordinate payment for your primary
Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
Example: Your company contracts with us to provide a health plan, and we provide your company with certain
statistics to explain the premiums we charge.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good,
such as public health and research. We have to meet many conditions in the law before we can share your information for
these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
● Preventing disease
● Helping with product recalls
● Reporting adverse reactions to medications
● Reporting suspected abuse, neglect, or domestic violence
● Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and
Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
● We can share health information about you with organ procurement organizations.
● We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
● For workers’ compensation claims
● For law enforcement purposes or with a law enforcement official
● With health oversight agencies for activities authorized by law
● For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
● We are required by law to maintain the privacy and security of your protected health information.
● We will let you know promptly if a breach occurs that may have compromised the privacy or security of your
● We must follow the duties and privacy practices described in this notice and give you a copy of it.
● We will not use or share your information other than as described here unless you tell us we can in writing. If
you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice
will be available upon request, on our website, and we will mail a copy to you