Friberg Medical Associates uses your health information for your treatment, to bill and receive payment for your treatment, for our administrative purposes and to evaluate the quality of care that you receive. You health information is contained in various forms, all of which belong to Friberg Medical Associates.

How Friberg Medical Associates May Use or Disclose Your Health Information

For treatment: Friberg Medical Associates may use your health information to provide you with medical treatment or services. For example, information obtained by our health care providers, such as a physician, nurse or other staff providing health care services to you will record your health information and services in your medical records and in our systems. This information is necessary for the health care providers to determine the best treatment for you. The health care providers also record their treatment actions and your response to that treatment.

For Payment: Friberg Medical Associates may use and disclose your health information to others for the purposes of receiving payment for our treatment and services that you receive. For example, a bill may be sent to a third party payer, such as a union or an insurance company. The billing may include information that identifies you, your diagnosis and the treatment and supplies used in providing our health care services to you.

Health Care Operations: Friberg Medical Associates may use and disclose your health information for our operational purposes. For example, we may disclose your information to our medical staff, risk or quality improvement staff and others to:

• Evaluate the performance of our staff;
• Assess the quality of care and outcomes in your case and similar cases;
• Learn how to improve our facilities and services; and
• Determine how to continually improve the quality and effectiveness of the health care we provide.

Friberg Medical Associates may use your information to make appointments for you at a Friberg Medical Associates facility or for you at one of our health care consultants or to provide appointment reminders to you either using mail or telephone messages. We may provide you with information regarding your treatment options or other health care benefits and services that may be important to you.

Friberg Medical Associates may find it necessary to use a language translator to most effectively provide our health care services to you. In addition, Friberg Medical Associates may find it necessary to communicate with your relative or otherwise authorized representative to ensure that proper communications are maintained related to providing your health care services.

As Required by Law: Friberg Medical Associates may use and disclose your health information as required by law. For example, Friberg Medical Associates may disclose information for the following purposes:

• For judicial and administrative proceedings pursuant to a legal authority;
• To report information related to victims of abuse, neglect or domestic violence; or
• To assist law enforcement officials in their enforcement duties.

Public Health: Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, disability or other health oversight activities.

Decedents: Your health information may be disclosed to funeral directors or coroners to enable them to perform their lawful duties.

Organ/Tissue Donation: Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.

Research: Friberg Medical Associates may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

Health and Safety: Your health information may be disclosed to avert a serious threat to the health and safety of you or any other person pursuant to any applicable law.

Government Functions: Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.

Workers Compensation: Your health information may be used or disclosed in order to comply with the laws and regulations related to Workers Compensation.

Your Health Information Rights

You have the right to:

• Obtain a paper copy of the Notice of Privacy Practices upon request;
• Request a restriction on certain uses and disclosures of your information as provided by law. However, Friberg Medical Associates is not required to agree to a requested restriction;
• Inspect and obtain a copy of your health record as provided by law;
• Amend your health records as provided by law. However, Friberg Medical Associates is not required to make any amendments that are known to be untrue;
• Request communications of your health information by alternative means or at alternative locations. However Friberg Medical Associates is not required to agree to an unreasonable request;
• Request that all communications regarding your private health information be confidential. However, Friberg Medical Associates is not required to agree to an unacceptable request;
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
• Receive an accounting of unauthorized disclosures made of your health information as provided by law.

Complaints

You may complain to Friberg Medical Associates and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing your complaint. Complaints made to Friberg Medical Associates should be directed to the Chief Privacy Officer.

Friberg Medical Associates Obligations

Friberg Medical Associates is required to:

• Maintain the privacy of your protected health information;
• Provide you with this notice of our legal duties and privacy practices with respect to your private health information;
• Abide by the terms of this notice;
• Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
• Obtain your written authorization to use or disclose your health information for marketing or research purposes or for any reason other than those listed above and permitted under law.

Friberg Medical Associates reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you by our normal means of communication.

Contact Information