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
We understand the confidential nature of the information you provide to Target Clinic. We want you to understand how Target Clinic may use and disclose certain information youprovide us, and what rights you have concerning that information.
creates that identifies you and concerns:
Target Clinic may use or disclose your protected information to provide you with treatment, obtain payment for your treatment, or perform health care operations. Some examples of how we may use or disclose your protected information for these reasons are:
Treatment. We may use or disclose your protected information to provide health care to you, or to manage your health care. For example, we may communicate with other health care providers, including doctors, nurses or pharmacists, to provide health care to you or manage your health care.
Payment. We may use or disclose your protected information to obtain payment for the services we provide you. For example, we may use or disclose your protected information to determine the amount of your co-payment responsibility and to obtain payment for your treatment from your insurer.
Health Care Operations. We may use or disclose your protected information for administrative purposes or for purposes of monitoring our operations. For example, we may use or disclose your protected information to review the performance of our staff, to prevent fraud and to develop compliance programs in order to offer you more effective and comprehensive treatment.
We may hire third parties to help us with these matters. We may disclose your protected information to these third parties so they can perform the services we request them to do. We require these third parties to agree that they will use your protected information only to provide the services we have requested.
Target Clinic may also use or disclose your protected information for other reasons. Those reasons and some examples of how we may use or disclose your protected information for those reasons are listed below. The examples are for illustration only, and are not intended to be all-inclusive.
Communications With You. We may use your protected information to contact you. We may contact you to provide appointment reminders, or to provide you with information about treatment alternatives or other health-related benefits, products and services that may be of interest to you.
Health Oversight Agencies. We may disclose your protected information to health oversight agencies. For example, we may disclose your protected information to agencies authorized by law to perform audits, investigations, inspections or other activities for the oversight of the health care system, government benefit programs, government regulatory programs or civil rights laws.
Individuals Involved in Your Care. We may disclose your protected information to family members, friends or any other person who is involved in your health care or payment for your care. For example, if a family member is present with you when we provide treatment to you or discuss your treatment with you, we may use our professional judgment in disclosing your protected information to that person.
Public Health Purposes. We may disclose your protected information for public health purposes. For example, we may disclose your protected information to authorities to prevent or control the spread of disease, to report abuse or neglect, to report adverse events or to enable product recalls.
As Required by Law. We may disclose your protected information as required by law. For example, we may disclose your protected information as may be required to report victims ofabuse or neglect, in response to requests from law enforcement, or in response to a court order, administrative order, subpoena, warrant, or other lawful process.
Special Circumstances. We may use or disclose your protected information in certain special circumstances. Such circumstances include disclosures to agencies authorized by law to collect information for national security and intelligence activities, for specialized government functions in the event you are a veteran or are in the military, for providing assistance in identifying you or locating you in the event of a disaster, for investigation of a death or identification of a deceased person, for research purposes, to avert a threat to health or safety of an individual or the public, to comply with requirements for workers’ compensation programs, or to facilitate organ, eye or tissue donation or transplantation.
Target Clinic will obtain your written authorization before using or disclosing your protected information for any reason other than those included in this Notice. You may revoke your authorization in writing at any time. Upon receipt of your written revocation, we will stop using or disclosing your protected information, except to the extent that we have already taken action in reliance on the authorization.
You have certain rights concerning your protected information and this Notice. These rights include:
Notice of breach. Target Clinic is required to notify you in the event there is a breach of your unsecured protected information that compromises the security or privacy of your unsecured protected information.
Inspection and Copies. You may request a copy of this Notice by contacting your local Target Clinic. You also have the right to inspect and receive a copy of the protected information we maintain about you. To the extent any of your protected information is maintained in an Electronic Health Record, you have the right to get a copy of your Electronic Health Record in an electronic format and, if you choose, to have us send such copy directly to a third party. To obtain a copy of your protected information, contact your local Target Clinic. Your local Target Clinic may request that you submit a written request. We may charge you a fee for the costs of copying and mailing your protected information.
Amendments. If you feel that the protected information we maintain about you is incomplete or incorrect, you may request that we amend it. To request an amendment, contact your local Target Clinic. Your local Target Clinic may request that you submit a written request. The request must include the reason you are requesting the amendment. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you may send us a written statement disagreeing with our denial.
Restrictions on Uses and Disclosures. You have the right to request additional restrictions on our use or disclosure of your protected information. Your request must be submitted in writing to your local Target Clinic. In general, we are not required to agree to any restrictions you request. If you pay for the full amount of your treatment or product out-of-pocket, however, we will honor requests to restrict disclosures to health plans or insurers for payment or health care operations purposes unless the disclosure is required by law. Your request must be submitted in writing to your local Target Clinic.
Accounting of Disclosures. You have the right to receive an accounting of the disclosures we have made of your protected information. The accounting will not include disclosures made for treatment, payment or health care operations, disclosures made directly to you, your friends or family members involved in your care, or disclosures authorized by you. The right to receive an accounting of disclosures is subject to certain other exceptions, restrictions, and limitations. To request an accounting of disclosures, contact your local Target Clinic. Your local Target Clinic may request that you submit your request in writing. The first accounting you request within a 12- month period will be provided free of charge, but you may be charged for the cost of additional accountings. We will notify you of the cost involved and you may then withdraw or modify your request.
Alternative Communications. You may request that we contact you about your protected information only in a certain manner (such as in writing or by phone) or only at a certainlocation (such as your home or place of work). We will accommodate reasonable requests. To make a request, you must submit your request in writing to your local Target Clinic.
Target Clinic may revise the terms of this Notice and make the new Notice effective for all of your protected information. If Target Clinic makes a material change to this Notice, a newNotice will be posted at your local Target Clinic and will be available to you upon request at your local Target Clinic.
This Notice is effective as of September 1, 2006. Target Clinic is required by law to maintain the privacy of your protected information and to provide you with this Notice. Target Clinic is required to comply with the terms of this Notice for so long as it is in effect.
Last updated May 7, 2013.