IAC Associates PLLC
6630 Summer Knoll Circle, Bartlett TN 38134
Your Information. Your Rights. Our Responsibilities.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll explain why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will identify as “IAC Associates” on all communications.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- We will not share information about substance use treatment [identified with you personally] without your written permission, and we will remind anyone receiving it not to disclose it.
- You can ask us not to use or share certain health information for treatment, payment, or our operations and we will comply with your request or explain why we cannot do so.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
- If you want us to apply to your insurance for payment, we will disclose only the minimum information required for billing and payment.
Get a list of those with whom we’ve shared information
- You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a copy of this notice at any time. We will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- If you feel that your rights have been violated, you can complain by contacting the Privacy Officer listed on the last page of this Notice.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us whether to:
- Share information with your family, friends, or others involved in your care
- Share information in a disaster situation
We will never share your information for marketing purposes.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information to treat you and can share it with other providers if it is necessary for your medical treatment. Remember that we will never disclose information about substance use without your written permission, except in legally exempt cases such as life-threatening situations when you are unable to give consent.
Example: A surgeon treating you after an automobile accident asks about your medication history.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage treatment among your IAC providers.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities, unless you prefer to pay out-of-pocket.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share limited health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Doing health research
What do we mean by limited information?
- In the event that we share your information for research or public health/safety purposes, your personal identifiers will be removed from it, including your name, birth date, social security number and any other way that you could be individually identified.
Comply with the law
- We will share information about you if state or federal laws require it but only in accordance with 42 CFR part 2
- with the Department of Health and Human Services to demonstrate compliance with federal privacy law
- reporting suspected abuse, neglect, or domestic violence
- preventing or reducing a serious threat to anyone’s health or safety
- sharing health information with a coroner or medical examiner if the need arises
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a properly executed subpoena (but will obtain legal advice before we do so).
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and offer you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
D. Michael Dunavant, U.S. Attorney for the Western District of Tennessee
Substance Abuse / Mental Health Services Administration’s Division of Pharmacologic Therapies
Effective Date: November 11, 2019 Privacy officer: Jayne Gipson, RN