Privacy Notice
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY
Effective Date: February 1, 2003
Once you sign the consent form for Urologic Associates of Allentown, PC, we may use and disclose medical information about you in order to complete your treatment, to obtain payment for services rendered to you and to perform the operations of the practice.
Examples of how we may use and disclose information are as follows:
Uses and disclosures for treatment
- If a nurse practitioner, physician or physician assistant at the practice refers you for a cardiac stress test and needs to call the cardiologist for results, the clinician may give your name and reason for ordering the test to the cardiologist’s office.
- A nurse practitioner, physician or physician assistant at the practice may call you from time to time to advise you of new alternatives to your treatment.
Uses and disclosures to obtain payment
- The practice's billing staff may submit a claim form containing your name, address, social security number, diagnoses and procedures performed in our office or other inpatient or outpatient settings to your insurance company.
Uses and disclosures to perform the operations of the practice
- The practice's nurse practitioners, physicians and physician assistants may audit (read and comment upon) your chart in order to track and improve our performance in assuring that screening test and immunizations are done on time.
- The practice's staff may mail you notices of upcoming appointments.
- We may leave a message at a telephone number you provide, asking you to return our call.
The practice may use or disclose protected health information about you for other purposes, without your consent, if we are required by law to disclose to government authorities. Examples of such uses or disclosures may include suspected domestic abuse or documented communicable diseases.
You may revoke your consent authorizing disclosure of your protected health information.