Please review our Notice of Privacy Practices and sign below to acknowledge that you have been given a copy of or an opportunity to read the practice’s Notice of Privacy Practices.
Starbuck Medical LLC
Effective Date: 01/1/2022
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact our privacy officer:
Crystal Starbuck
8341 Wolf Lake Drive
Piedmont, OK 73078
United States
(405) 633-3996
Starbuck Medical LLC is committed to preserving the privacy and confidentiality of your health information, as required by law. We are required by law to provide you this notice describing:
Our legal duties
Your rights
Our privacy practices related to your health information
Each time you visit us, we make a record of your visit. Typically, this record contains:
Your symptoms
Examination and test results
Our assessment of your condition
A record of your treatment interventions
A plan for future care or treatment
We will only use or disclose this information in limited circumstances.
We may use and disclose your health information to:
Plan your care and treatment
Provide treatment by us or others
Communicate with other providers
Receive payment from you, your health plan, or your insurer
Make quality assessments and improve care (health care operations)
Make you aware of services and treatments of interest
Comply with laws requiring disclosure
We may also use or disclose your information when you authorize us to do so.
You have the right to:
Ensure the accuracy of your health record
Request confidential communications
Request limits on the use and disclosure of your health information
Request an accounting of certain uses and disclosures
We are required to:
Maintain the privacy of your health information
Provide you with this Notice of Privacy Practices
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable requests for alternative communications
We reserve the right to change our practices and apply the new provisions to all health information we maintain. If there is a material change, we will provide you a revised notice as required by law.
We may use and disclose your protected health information to provide, coordinate, and manage your care, including consulting with other providers or referring you to specialists.
We may use and disclose your health information for billing and payment purposes, such as:
Verifying insurance benefits
Billing your insurer
Sending bills to you or family members
Working with collection agencies or courts if payment is overdue
We may use and disclose your health information to:
Assess care and outcomes
Improve quality and effectiveness
Conduct cost-management and planning
Students or interns may observe or participate in your care. You have the right to refuse student involvement.
We may share health information with third-party contractors (e.g., billing services, consultants) who must protect your information.
We may contact you to remind you of appointments. You can request alternative communication methods.
We may inform you of:
Alternative treatments
Health-related benefits and services
We may disclose health information to individuals involved in your care, unless you object.
We may contact you with newsletters or other information, subject to applicable laws.
We may disclose your health information to disaster relief organizations.
We will not use your health information for marketing without written authorization, except in limited cases such as nominal promotional gifts or face-to-face discussions.
We may use certain information to contact you about fundraising. You may opt out at any time.
We may disclose information for public health purposes, such as:
Reporting disease, injury, or births and deaths
Reporting child abuse or neglect
Notifying persons exposed to disease
Reporting to authorities about victims of abuse
We may disclose information about adverse events to regulatory agencies.
We may share your information for research if permitted by law or approved by a review board.
We may disclose information to comply with workers’ compensation laws.
We may release information:
In response to legal processes
To locate a suspect or witness
About crime victims
To report a death or crime
To authorized officials for security purposes
We may create and use de-identified information that does not identify you.
We will treat your personal representative as you regarding disclosures.
Results will not be disclosed without your consent unless required by law.
We may provide limited data sets for research or public health if safeguards are in place.
Other uses not described in this notice require your written authorization. You may revoke authorization at any time in writing, except where action has already been taken.
Right to Obtain a Paper Copy of This Notice
You have the right to a paper copy of this notice at any time.
Right to Inspect and Copy
You may inspect and copy your health records by submitting a written request. We may charge a reasonable fee.
Right to Amend
You may request amendments to your health information in writing, with a reason for the request.
Right to an Accounting of Disclosures
You may request an accounting of disclosures by submitting a written request. The first request in a 12-month period is free.
Right to Request Restrictions
You can request restrictions on how we use or disclose your information. We are not required to agree, except as required by law when you pay out-of-pocket.
Right to Request Confidential Communications
You can request communication through specific means or locations.
Right to Receive Notice of a Breach
We will notify you of any breaches of unsecured protected health information.
If you believe your privacy rights have been violated, you may file a complaint with:
Starbuck Medical (contact our privacy officer)
Secretary of the U.S. Department of Health and Human Services
Complaints must be in writing. You will not be penalized for filing a complaint.
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