NOTICE OF PRIVACY PRACTICES
Note: This Notice of Privacy Practices is provided for educational and informational purposes only.
This Notice is not intended as legal advice, and is not provided for adoption or publication by any
party. The publication of any such notice may create legal obligations or liabilities which may vary
depending upon the legal status and business operations of different organizations. The form and
content of any Notice of Privacy Practices should be determined only upon informed consultation
with qualified legal counsel, including consideration of any state laws that are more stringent than
the rights outlined in this Notice.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
IT CAREFULLY.
THIS NOTICE IS EFFECTIVE April 14th, 2003 UNTIL FURTHER NOTICE.
Legal Requirements
DR DOYLE HOLLE is required by law to maintain the privacy of your protected health information.
We are required to abide by the terms of this notice as it is currently stated, and reserve the right
to change this notice and make the new policies effective for all protected health information that
we maintain. The policies in any new notice will not be in effect until they are posted to this site
and are available in our office. We will make any new notice available to you upon request.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Routine Uses and Disclosures of Protected Health Information for Treatment, Payment or
Health Care Operations
As a patient, you have certain rights relating to the uses and disclosures of your protected health
information. Under the Health Insurance Portability and Accountability Act (HIPAA), DR DOYLE
HOLLE can use and disclose your protected health information without your specific permission
for treatment, payment and health care operations.
Set out below are examples of the uses and disclosures of your protected health information DR
DOYLE HOLLE is permitted to make for these routine purposes. While this list is not exhaustive, it
should give you an idea of the everyday uses and disclosures "behind" the scenes that are
essential to the care you receive.
a) Treatment - We may use or disclose your health information for purposes of providing
treatment to you. For example, your protected health information will be used to diagnose and
counsel you regarding your health condition and appropriate treatment options.
We may also use and disclose your protected health information to provide you with information
regarding possible alternative treatment options and other health-related benefits and services
that we believe might interest you. For example, we may use or disclose your health information to
provide you with appointment reminders via phone, e-mail or letter.
b) Payment - We may use and disclose your health information to obtain payment for services we
provide you. For example, we may communicate your protected health information to you
insurance company so that it can process payment for your office visit.
c) Health care operations - We may use and disclose your health information in connection with
our healthcare operations. Healthcare operations include quality assessment and improvement
activities, reviewing the competency or qualifications of healthcare professionals, evaluating
provider performance, conducting training programs, accreditation, certification, licensing or
credentialing activities.
Other Uses and Disclosures of Protected Health Information DR DOYLE HOLLE is
Permitted or Required to Make Without Your Authorization
Most uses and disclosures that do not fall under treatment, payment, or health care operations will
require your written authorization. However, there are exceptions to this general rule pursuant to
which we are permitted or required to make certain uses and disclosures or your protected health
information. These situations include:
Required by the Secretary of Health and Human Services
We may be required to disclose your protected health information to the Secretary of Health and
Human Services to investigate or determine our compliance with the federal privacy law.
Required by Law
We may also use or disclose your health information when we are required to do so by state or
federal law.
Public Health: We may disclose your protected health information for public health activities,
such as disclosures to a public health authority or other government agency that is permitted by
law to collect or receive the information (e.g., the Food and Drug Administration).
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe that
you are a possible victim of abuse, neglect, or domestic violence or the victim of other crimes.
Health Oversight
We may disclose protected health information to a health oversight agency for activities
authorized by law, such as: civil or criminal investigations; inspections; licensure or disciplinary
actions; or other activities necessary for appropriate oversight, governmental health benefit
programs, or compliance with laws.
Judicial and Administrative Proceedings
We may disclose protected health information in response to a court or agency order, and, in
some cases, in response to a subpoena or other lawful process not accompanied by a court
order.
Law Enforcement
We may disclose protected health information for law enforcement purposes, such as providing
information to the police about the victim of a crime.
Coroners, Medical Examiners, and Funeral Directors
We may disclose protected health information to a coroner, medical examiner, or funeral director
if it is needed to carry out their duties. We also may disclose protected health information to
facilitate organ donation or transplantation.
Research
We may disclose your protected health information to researchers when the research is being
conducted under established protocols to ensure the privacy of your information.
Serious Threat to Health or Safety
Your protected health information may be disclosed if we believe it is necessary to prevent a
serious and imminent threat to the public health or safety and it is to someone we reasonably
believe is able to prevent or lessen the threat.
Emergency Situations
In the event of your incapacity or an emergency situation, we will disclose health information to a
family member, or another person responsible for your care, using our professional judgment. We
will only disclose health information that is directly relevant to the person's involvement in your
healthcare.
National Security
We may disclose the health information of Armed Forces personnel to military authorities under
certain circumstances. We may disclose health information to authorized federal officials required
for lawful intelligence, counterintelligence and other national security activities.
Inmates
We may disclose health information of inmates to the appropriate authorities under certain
circumstances.
Workers' Compensation
Your protected health information may be disclosed to comply with workers' compensation laws
and other similar programs.
Disclosures to Other Parties for Conducting Permitted Activities
DR DOYLE HOLLE may conduct the above-described activities ourselves, or we may use other
entities to perform those operations. In those instances where we disclose your protected health
information to a third party acting on our behalf, we will protect your protected health information
through an appropriate privacy agreement.
Other Uses and Disclosures of Protected Health Information Based Upon Your Written
Authorization
Marketing
We will not use your health information for marketing communications without your written
authorization.
Other uses and disclosures of your protected health information not described above will be made
only with your written authorization. You may revoke your authorization (in writing) through our
practice at any time, except to the extent that we have taken action in reliance on the
authorization.
YOUR RIGHTS
You have the right to request a restriction on certain uses and disclosures of your
protected health information. This means that you may ask us not to use or disclose any part of
your protected health information for purposes of treatment, payment, or health care operations.
You may also request that any part of your protected health information not be disclosed to family
members or friends who may be involved in your care. Your request must be in writing and must
state the specific restriction requested and to whom you want the restriction to apply.
DR DOYLE HOLLE is not required to agree to such a restriction. If we do agree, we will abide by
your restriction unless we need to use your protected health information to provide emergency
treatment. In addition, we may elect to terminate the restriction at any time.
You have the right to request to receive information from us by an alternative means or at
an alternative location if you believe it would enhance your privacy. For example, you may
request that we send written communications to an alternative address. We will attempt to
accommodate all reasonable requests, and will not request an explanation from you as to the
basis for your request.
You have the right to inspect and copy your protected health information. If you would like
to see or copy your protected health information, we are required to provide you access to your
protected health information for inspection and copying within 30 days after receipt of your request
(60 days if the information is stored off-site). We may charge you a reasonable fee to cover
duplicating costs. In addition, there may be situations where we may decide to deny your request
for access. For example, we may deny your request if we believe the disclosure will endanger
your life or health, or that of another person. Depending on the circumstances of the denial, you
may have a right to have this decision reviewed.
You have the right to amend your protected health information. This means you may request
an amendment of your protected health information in our records for as long as we maintain this
information. We will respond to your request within 60 days (with up to a 30-day extension, if
needed). We may deny your request if, for example, we determine that your protected health
information is accurate and complete. If we deny your request, we will send you a written
explanation and allow you to submit a written statement of disagreement.
You have the right to receive an accounting of certain disclosures we have made of your
protected health information. An accounting is a record of the disclosures that have been made
of protected health information. This right generally applies to non-routine disclosures, i.e., for
purposes other than treatment, payment, or health care operations as described in this Notice,
made in the six-year period prior to your request (although you are free to request an accounting
for a shorter period). We are required to provide the accounting within 60 days (with one 30-day
extension, if needed) and to provide one accounting free of charge in any 12-month period (for
more frequent requests, a reasonable fee may be charged).
You have the right to obtain a paper copy of this notice from DR DOYLE HOLLE.
COMPLAINTS
If you believe your privacy rights have been violated, you have the right to report such alleged
violations to DR DOYLE HOLLE, and we will promptly investigate the matter. You may file a
complaint with DR DOYLE HOLLE by contacting our office. Rest assured we will not retaliate
against you in any way for filing a complaint about our privacy practices. You may also contact the
Secretary of Health and Human Services.
For further information about DR DOYLE HOLLE's privacy policies, please contact our Privacy
Officer at the following address or phone number:
DR DOYLE HOLLE
4015 S. MCCLINTOCK DR.,STE.107
TEMPE, AZ, 85282-5877
(480) 345-0090