Patient Notice-Of-Privacy Policy

(Good faith effort to get patient’s awareness)

(To be given to all patients)

POLICY ON CONFIDENTIALITY AND PRIVACY:  Keeping your medical records confidential

What you need to know about AFC Confidentiality Policy:

AFC is committed to providing you with high quality health care and to forming a relationship with you that is built on trust. That means respecting your privacy and confidentiality of you medical information. We protect your privacy and confidentiality rights by creating and putting into practice policies and procedures that allow access to your personal medical information only for legitimate reasons.

Your medical record:

As we provide your health care, we are required to maintain a complete copy of your medical history, current condition, treatment plan and all treatment given, including the results of all tests, procedures and therapies. Whether this information is stored in writing, on a computer, or other means, we will keep this information in a safe and secure way that protects your privacy and confidentiality. Of course, the physicians and other health care professionals who are involved in your care need to access this information in order to provide appropriate treatment for you.

Your medical information is private and confidential:

You, or anyone to whom you give written permission, or your legal representatives, have the right to read or get a copy of your medical information. Your medical record is the physical property of AFC.

How do we assure your privacy:

AFC has put in place detailed policies regarding access to medical records by our staff and employees and has carefully outlined the circumstances under which your medical information may be released to parties outside AFC. These policies conform with state and federal law and are designed to safeguard your privacy. Our staff and employees are trained in the appropriate use of medical information and know that it is available to them only to continue to provide care to you or for other limited but legitimate reasons. A violation of confidentiality or the failure of an employee to protect your information from accidental or unauthorized access will not be tolerated. This may include the employee being fired from his or her job.

We ask for your permission:

We do not allow others outside AFC to access your medical information unless we have the appropriate authorization to do so. We will request your authorization to release information at your first visit or admission. In addition, some laws prevent certain types of patient information from being released without specific patient permission. Examples include, but are not limited to:

Confidential details of:

• Psychotherapy (from records of my treatment by a psychiatrist, licensed psychologist or psychiatric clinical nurse specialist)

• Other professional services of a licensed psychologist

• Social Work Counseling/Therapy

• Domestic Violence Victims’ Counseling

• Sexual Assault Counseling

HIV test results (Patient authorization required for EACH release request.)

Records pertaining to Sexually-Transmitted Diseases

Alcohol and Drug Abuse Records

Please note, however, that the law requires some information to be disclosed in certain circumstances. This includes mandatory reports of abuse of children or elderly or disabled persons. Also, subpoenas or court orders may compel the disclosure of confidential or privileged health information in the context of a lawsuit or administrative proceeding. Medical records are sometimes used for reasons other than patient care. For example, records are periodically reviewed to evaluate the quality of care, or to be sure that AFC follows the rules of regulatory agencies for the efficient and effective utilization of care such as Medicare, Department of Public Health, or Department of Mental Health. Your insurance company may request information that we are required to submit in order to provide and bill for your care. Anyone reviewing records must follow the same confidentiality laws and rules required of all health care providers. Patient records are valuable tools used by researchers in finding the best possible treatments for diseases and medical conditions. All researchers must follow the same rules and laws that other health care workers are required to follow to insure the privacy of patient information. Information that may identify you will not be released to anyone outside AFC without your written approval. In all research conducted within AFC, concern for your privacy and well-being is our first priority.

If you have questions:

If you have questions about the privacy of your medical records, please speak with your physician or a member of his or her office staff, as appropriate.  We will be happy to help you.