HIPAA Notice of Privacy Practices
This notice describe how your medical information may be used and disclosed and how you can get access to this
information. Please review it carefully. If you have any questions about this notice, please contact the practice
administrator.
We Are Required by Law to:
Maintain the privacy of protected health information
Give you this notice of our legal duties and privacy practices regarding your health information
Follow the terms of our notice that is currently in effect
Changes to This Notice:
We reserve the right to change this notice and make the new notice apply to Health Information we already have as
well as any information we receive in the future. We will post a copy of our current notice at our office.
Complaints:
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of
the Department of Health and Human Services. All complaints must be made in writing and addressed to our office,
ATTN: Privacy Officer. You will not be penalized for filing a complaint.
Your Rights
You have the following rights regarding your Health Information;
Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make
decisions about your care or payment for your care. This includes medical and billing records, other than
psychotherapy notes.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment for as long as the information is kept by our office.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of
Health Information for purposes other than treatment, payment and health care operations or for which you provided
written authorization.
Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information
we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the
Health Information we disclose to someone involved in your care or the payment for your care, like a family member
or friend. We are not required to agree to your request. If we agree, we will comply with your request unless the
information is needed to provide you with emergency treatment.
Right to Request Confidential Communication. You have the right to request that we communicate with you
about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by
mail or at work. Your request must specify how or where you wish to be contacted. We will accommodate reasonable
requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give
you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice.3260 Providence Dr, Suite C-322
Anchorage, AK 99508
Phone: (907) 563-7228
Fax: (907) 563-6278
www.akwomenshealth.com
How We May Use and Disclose Health Information
Described as follows are the ways we may use and disclose health information that identifies you (Health
Information). Except for the following purposes, we will use and disclose Health Information only with your
written permission. You may revoke such permission in writing, any time.
Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-
related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or
other personnel, including people outside our office, who are involved in your medical care and need the
information to provide you with medical care.
Payment. We may use and disclose Health Information so that we or others may bill and receive payment from
you, an insurance company, or a third party for the treatment and services you received.
Health Care Operations. We may use and disclose Health Information for health care operation purposes. These
uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and
manage our office. For example, we may use and disclose information to make sure the obstetrical or gynecological
care you receive is of the highest quality. We also may share information with other entities that have a relationship
with you (for example, your health plan) for their care operation activities.
Appointment Reminders, Treatment Alternatives, and Health Related Benefits and Services. We may use
and disclose Health Information to contact you and to remind you that you have an appointment with us. We also
may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and
services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health
Information with a person who is involved in your medical care or payment for your care, such as your family or
close friend. We also may notify your family about your location or general condition or disclose such information
to an entity assisting in a disaster relief effort.
Special Situations
As Required by Law, We will disclose Health Information when required to do so by international, federal, state or
local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to
prevent a serious threat to your health and safety or the health and safety of the public or another person.
Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates that perform functions on
our behalf or provide us with services if the information is necessary for such functions or services. For example,
we may use another company to perform billing services on our behalf. All of our business associates are obligated
to protect the privacy of your information and are not allowed to use or disclose any information other than as
specified in our contract.3260 Providence Dr, Suite C-322
Anchorage, AK 99508
Phone: (907) 563-7228
Fax: (907) 563-6278
www.akwomenshealth.com
Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to
organizations that handle organ procurement or other entities engaged in procurement; banking or transportation of
organs, eyes, or tissues to facilitate organ, eye or tissue donation; and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required
by military command authorities. We also may release Health Information to the appropriate foreign military
authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs.
These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose Health Information for public health activities. These activities generally
include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or
neglect; report reactions to medications or problems with products; notify people of recalls of products they may be
using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or
condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or
domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities
authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the health care system, government programs, and
compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in
response to a court or administrative order. We also may disclose Health Information in response to a subpoena,
discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been
made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is:
(1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify
or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under
certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may
be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a
crime, the location of the crime or victims, or the identity, description or location of the person who committed the
crime.
Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner or
medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of
death. We also may release Health Information to funeral directors as necessary for their duties.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a
law enforcement official, we may release Health Information to the correctional institution or law enforcement
official. This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your
health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.