Other than the uses and disclosures described above (#1-6), we will not use or disclose medical information about you without the “authorization” – or signed permission – of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will ask you to sign an authorization form.
If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action.
You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer at 515-235-5224.
1. Right to a Copy of This Notice
You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area. If you would like a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer at 515-235-5224.
2. Right of Access to Inspect and Copy
You have the right to inspect (which means see or review) and received a copy of medical information about you that we maintain in certain groups of records. If we maintain your medical records in an electronic health record (EHR) system, you may obtain an electronic copy of your medical records. You may also instruct us in writing to send an electronic copy of your medical records to a third-party. If you would like to inspect or receive a copy of medical information about you, you must revive us with a request in writing. You may write us a letter requesting access.
We may deny your request in certain circumstances. If we deny your request, we will explain our reasons for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person.
If you would like a copy of the medical information about you, we will charge you a fee to cover the costs of the copy. Our fees for electronic copies of your medical records will be limited to the direct labor costs associated with fulfilling your request.
We may also be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information on these services and their associated fees.
3. Right to have Medical Information Amended
You have the right to have us amended (which means correct or supplement) medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing and explain what you would like us to amend within the information. You must write a letter to us requesting an amendment.
We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future.
4. Right to an Accounting of Disclosures We Have Made
You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting you may send us a letter requesting an accounting, or contact our Privacy Officer.
The accounting will not include several types of disclosures, including disclosures for treatment, payment or healthcare operations. If we maintain your medical records in an Electronic Health Record (EHR) system, you may request the accounting to include disclosures for treatment, payment or health care operations. The accounting will also not include disclosures made prior to April 14, 2003.
If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the cost of preparing the accounting.
5. Right to Request Restrictions on Uses and Disclosures
You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and health care operations. Under federal law, we must agree to your request and comply with your requested restriction(s) if: