You have the following rights regarding your PHI:
Restrictions: You have the right to ask us to restrict the way we use or
disclose your PHI for treatment, payment and health care operations. To request restrictions,
your request must be in writing to our office. We will consider your request for restrictions,
but we are not required by law to agree to them. If we agree to restrictions, we will put
the restrictions in writing and follow them, except in an emergency situation. You may not
restrict the uses and disclosures that we are required or allowed to make by law.
Access: You have the right to obtain a copy and to review PHI that we have
at our facility, with some exceptions:
- It is the policy of Tri-Life Center L.L.P. that records are reviewed with a practitioner
prior to obtaining copies of your PHI;
- You may not receive a copy or review psychotherapy notes or other information prohibited
by law;
- We may charge a reasonable fee for copies and postage; and
- We may deny your access request in limited situations.
Amendment: You have the right to ask us to amend your PHI if you believe that
the PHI we have is incomplete or incorrect. You must request an amendment and provide a
reason to support your request in writing to our Privacy Office. We may deny your request
in certain cases. For example, we may deny your request if the information we have is
accurate and complete or if the medical information was not created by our facility.
Disclosure Accounting: You have the right to ask us to for a list of disclosures
that we made of your PHI. You have a right to receive specific information about disclosures
that were made after April 14, 2003. We may charge you for reasonable copies. This list will
not include the following:
- Disclosures for treatment, payment or health care operations;
- Disclosures to you or your legal representative;
- Disclosures that you or your legal representative authorized; and
- Certain other disclosures as allowed by law.