FORM #1 - ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY POLICIES

This notice describes how medical information about you may be used, disclosed, and how you can get access to this information.

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  • Notice of Information Practices

  • This notice describes how medical information about you may be used, disclosed, and how you can get access to this information.

     

               

  • USES AND DISCLOSURE OF HEALTH INFORMATION

    Temah Healthcare Services, LLC may seek your consent to use health information about your treatment to obtain payment for treatment, for administrative purposes, and to evaluate the quality of healthcare that you receive. You can revoke your consent.

     

    Temah Healthcare Services, LLC may use or disclose identifiable health information about you without your authorization for public health purposes, for auditing purposes, for research studies, and for emergencies. We provide information when otherwise requested by law, such as for law enforcement in specific circumstances. In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you may later revoke the authorization to stop any future uses or disclosures, however, it has to be in writing.  

     

    INDVIDUAL RIGHTS

    In most cases, you may have the right to look at request a copy of health information about you that Temah Healthcare Services, LLC uses to make decisions about your health. If you request copies, we will charge you for retrieval fee, copying, and postage. You also have the right to receive a list of instances where we disclosed health information about you for reason other than treatment, payment, or related administrative purposes. If you believe that the information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information.

     

    COMPLAINTS/QUESTIONS

    If you are concerned that Temah Healthcare Services, LLC has violated your privacy right or you disagree with a decision we made about access to your records, you may contact our Privacy Contact at 410-521-8000 or the U.S Department of Health and Human Services. You will not be penalized for filing a complaint.

     

    If you have any questions about this Notice or concerns, please contact our Office at 5310 Old Court Rd, Ste 303, Randallstown, MD 21133. Phone # 410-521-8000

     

    OUR LEGAL DUTY

    We are required by law to provide individuals with this notice of our legal responsibilities and privacy practices with respect to Protected Health Information. We are also required to maintain the privacy of, and abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at the number listed above. You may request a copy of our HIPPA Notice of Privacy Practices.

     

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