MIDTOWN FAMILY MEDICINE-

OFFICE OF DR. M. MONTOYA AND DR. D. ORTIZ

 

ABBREVIATED NOTICE OF PRIVACY PRACTICES

 

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPPA.)

This notice is a summary of how health information about you, as a patient of this practice, may be used and disclosed and how you can get access to your individually identifiable health information.  A complete Privacy Notice is posted in our office and you may request a copy of your records.

 

OUR COMMITMENT TO YOUR PRIVACY:

Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called Protected Health Information, or PHI.)

 

WE MUST PROVIDE YOU WITH THE FOLLOWING IMPORTANT INFORMATION:

  • How we may use and disclose you PHI

  • Your privacy rights in your PHI

  • Our obligations concerning the use and disclosure of your PHI.

 

  1. Treatment. Our practice may use your PHI to treat you.

  2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us.

  3. Health care operations. Our practice may use and disclose your PHI to operate business.

  4. Appointment reminders. Our practice may use and disclose your PHI to contact you and remind you of your appointments.

  5. Release of information to family and friends. Our practice may use and disclose your PHI to a friend or a family member that is involved in your care, or who assists in taking care of you.

  6. Disclosure required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

Please be aware that the lawful use and disclosure of your PHI may be used in certain special circumstances such as public health risks, healthcare oversight activities, workers compensation matters, and others listed in the complete Privacy Notice posted in our office.

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YOU HAVE THE FOLLOWING RIGHTS REGARDING YOUR PHI:

 

  1. Confidential communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.

  2. Requesting restrictions of your PHI must be in writing.

  3. Inspection and copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.

  4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete. Request must be in writing.  

  5. Right to a paper copy of this notice.

  6. Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.

 

If you have any questions regarding this notice or our health information privacy policies, please contact a member of Midtown Family Medicine.

Midtown Family Medicine

1821 Carlisle Blvd NE, Albuquerque, NM 87110

For Life-Threatening Emergencies Call 911
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