Please read this information carefully. This notice explains how your personal and medical information may be used and how you can gain access to it.

When you visit a medical office and see a physician and/or any other health care provider, a record is made. This record contains information such as: –  Demographic Information
–  Social Security Number
–  Home Address
–  Telephone Number
–  Birth Date
–  Health Insurance Information
–  How you say you feel
–  Health conditions you have
–  Treatments you received
–  Diagnosis and care plans
–  Observations by health care providers

Health Information Uses and Disclosures

In order to serve you efficiently, there are instances when we use and disclose (give out) your health information:

Treatments

Your information will be provided to doctors, nurses and other health care workers that are involved in your care. This is necessary so that your plan of care can be carried out efficiently and effectively.

Payment

We will provide information about the care you received in our office to your insurance provider (s). On occasion, your health insurer may request details regarding procedure (s) performed during your visit. Some insurers require pre-approval for certain levels of care and we would provide the necessary information for that purpose as well. This process will help you receive benefits from your health insurer in a timely and concise manner.

Health Care Operations

To continually improve the quality of service we provide; we may use your information to conduct studies. The results are generally used to determine if our services are meeting the needs of our community. We may also contact you or send you a survey to collect comments on the service we provided to you.

Legal Requirements

–  Regulatory agencies that require information for audits, investigations and licensing due to administrative oversight.

–  Reporting your information to all the necessary parties involved in a Workers’ Compensation case as required by law.

I understand that this practice may not release my protected health information without my written consent, except in cases of Treatment, Payment or Healthcare Operations. 

I understand that if I send electronic mail or text messages to the office or staff that my private health information may NOT be protected. I understand that signing this document acknowledges that I have received a Patient Privacy Notice from the office of Dr. Anetta Reszko that indicates “use and disclosure” information as well as identifies and explains my patient rights.