HIPAA Privacy Notice

This notice describes how medical information about you may be used and shared and how you can get access to this information. Please review it carefully.

Uses and Disclosures of Your Medical Information

1. Treatment. Your “Protected Health Information” is routinely shared among health care professionals involved in your care to coordinate or manage treatment, both within and outside Polizzi Clinic. Laboratory results, for example, may be shared with a rehabilitation hospital as part of your discharge planning.

2. Health Care Operations. Your medical information is sometimes used to assess and improve quality of care or reallocate resources. Non-patient-specific information is used wherever possible. The details of your course of treatment, for instance, may be shared among the treatment team to evaluate your treatment based on the outcome.

3. Facility Directory. Unless you tell us not to, we may use the following information in a facility directory: (a) your name; (b) your location in Polizzi Clinic; and (c) your general condition. We may share this information with persons who ask for you by name. You may limit or prohibit these uses and disclosures by notifying a Polizzi Clinic representative orally or in writing of your restriction or prohibition. In an emergency or if you cannot tell us what you want us to do, we will do what we think you would want us to do, based on your other visits to Polizzi Clinic (if any). We will tell you about any uses or disclosures as soon as we can and give you a chance to object as soon as practicable.

4. State Law. State law mandates sharing of your medical information with state agencies under certain circumstances, without your consent. Examples include abuse reporting to the Department of Social Services and death reports to the Office of the Medical Examiner.

5. Medical Research. Your medical information may be used to further medical research, but only with your written permission or under conditions when written permission is not required by federal or state law.

6. Other Uses and Disclosures. Any other sharing of your medical information will be made only with your written permission, and you may take back your permission at any time so long as you tell us in writing. Exceptions include if Polizzi Clinic has acted in reliance upon your permission.

In addition, Polizzi Clinic may contact you to remind you about your appointment or tell you about health-related benefits or services that may be of interest to you. We may use certain information (name, address, telephone number, dates of service, age and gender) to contact you in the future for patient surveys, fundraising opportunities, or to evaluate your long-term outcomes. If you do not wish to be contacted for any of these reasons, you can notify a Polizzi Clinic representative at (801) 277-7740 or 4460 South Highland Drive, Suite 200, Salt Lake City, Utah 84124.

Your Rights

1. You may ask us to further limit our sharing of your information, but Polizzi Clinic does not have to agree to what you ask.

2. You have the right to receive confidential communications of your information at alternative locations or by alternative means.

3. You have the right to see and get a copy of your medical records.

4. If you think there is something wrong or missing in your medical information, you can ask that it be changed, unless the information was created elsewhere, is unavailable or is determined to be already accurate and complete.

5. You have a right to ask us for a limited accounting of disclosures of your information. The medical records department can provide you with more details.

The Duties of Polizzi Clinic

1. Polizzi Clinic is required by law to keep your medical information private and to give patients this notice of its legal duties and privacy practices for medical information. Polizzi Clinic is required to agree to the terms of this notice. Polizzi Clinic reserves the right to change the terms of this notice and to make the new terms apply to all medical information it keeps. This notice and any changed notices will be conspicuously posted in public spaces at the Clinic, made available on the Polizzi Clinic Web site (www.polizziclinic.org/hipaa) and given to you in paper copy upon your request.

2. Any patient believing that his or her privacy rights have been violated may complain through the Polizzi Clinic at (801) 277-7740 or file a complaint directly with the Secretary for the United States Department of Health and Human Services. Visit www.hhs.gov/ocr/privacy/hipaa/complaints to learn more. Patients will not be retaliated against for filing a complaint.

3. For questions about this notice or your privacy, contact Polizzi Clinic at (801) 277-7740 and ask to speak to a patient advocate.