Effective Date: 8/28/2025
Clinic Name: Authorized Pulmonary Testing Clinic
This Notice of Privacy Practices (“Notice”) describes how we may use and disclose your medical information and how you can access this information. Please review it carefully.
Your health information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
1. Our Responsibilities
We are required by law to:
Keep your protected health information (PHI) private and secure.
Provide you with this Notice of our legal duties and privacy practices.
Notify you if a breach occurs that may compromise your health information.
Abide by the terms of this Notice.
2. How We May Use and Disclose Your Health Information
We may use and share your health information without your written authorization in the following situations:
Treatment: To provide, coordinate, or manage your healthcare and related services, including sharing with doctors, specialists, pharmacies, or hospitals.
Payment: To bill and collect payment from insurance companies, government programs, or other payers for services you receive.
Healthcare Operations: To run our clinic, evaluate staff performance, improve services, and ensure quality of care.
Other uses and disclosures may include:
Appointment reminders and follow-ups.
Public health reporting (e.g., infectious diseases).
Reporting to health oversight agencies (e.g., licensing boards, audits).
To comply with law enforcement or court orders.
To avert serious threats to health or safety.
To support organ and tissue donation, research (with safeguards), or workers’ compensation claims.
3. Uses and Disclosures Requiring Your Authorization
We will not use or share your information without your written permission for:
Marketing purposes
Sale of your information
Psychotherapy notes (if applicable)
If you provide authorization, you may revoke it at any time in writing.
4. Your Rights Regarding Your Health Information
You have the right to:
Get a copy of your medical record: Ask to see or get an electronic or paper copy. We may charge a reasonable fee.
Request corrections: If you think your information is incomplete or incorrect, you may ask us to correct it.
Request restrictions: You may request limits on how your information is shared for treatment, payment, or operations.
Request confidential communications: You may ask us to contact you in a specific way (e.g., phone, email, or mailing address).
Get a list of disclosures: You may request a record of when and with whom we shared your information.
Receive a paper copy of this Notice: Even if you have agreed to receive it electronically.
File a complaint: If you believe your rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS). We will not retaliate against you for filing a complaint.
5. Data Security and Record Retention
We use safeguards to protect your information against unauthorized access, loss, or misuse. Records are retained as required by federal and state law, and securely destroyed when no longer needed.
6. Changes to This Notice
We may change this Notice at any time. Updated Notices will be posted in our clinic and available upon request. The new Notice will apply to all health information we maintain.
7. Contact Information
If you have questions, want to exercise your rights, or wish to file a complaint, please contact:
Privacy Officer
Authorized Pulmonary Testing Clinic
[Clinic Address]
[Phone Number]
[Email Address]
You may also file a complaint directly with the U.S. Department of Health & Human Services, Office for Civil Rights:
Website: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
Phone: 1-800-368-1019
We will not retaliate against you for filing a complaint.