The Health Insurance Portability and Accountability Act (HIPAA) requires that medical practitioners provide all patients with a notice that describes how personal health information (PHI) may be used and disclosed as well as patients rights’ and medical provider duties regarding this information. Please review the following which is provided in compliance with HIPAA.

Treatment: Your PHI will be used as necessary to provide optimal medical care. Information may be disclosed to other physicians, nurses or members of the healthcare team.

Payment: Your PHI may be disclosed in order to bill and receive payment from your insurance carrier, and is sometimes required in advance to pre-certify payment by insurers.

Business Operations: While committed to the highest possible level of privacy, there may be times when your PHI is disclosed to facilitate quality improvement initiatives, or for the purposes of general business operations including billing. Whenever possible, this information will be de-identified.

Appointment Reminders: Your PHI will be minimally disclosed when messages are left reminding you of upcoming appointments.

Release of Information to Family or Friends: ONLY with your written or documented verbal permission, your PHI maybe shared with friends or family of your designation, including those who accompany you to appointments or assist in your care.

Legally Required Uses and Disclosures: There are cases in which your PHI may be shared without your permission, including reportable diseases, reportable patterns of injury, abuse or neglect, events such as births and deaths, reactions to medications, for audits, investigations, and licensure, for judicial proceedings, warrants, subpoenas, as well as to avert a serious threat to safety or health.

You have the Following Rights:

  • To request restrictions on certain uses and disclosures, which may or may not be granted.
  • To receive confidential communications.
  • To inspect and copy PHI, provided such inspection has not been deemed a danger to your health or the health of others.
  • To request the amending of PHI should you find it to be incomplete or in error.
  • To receive an accounting of disclosures of PHI.
  • To obtain a paper copy of this notice from the practice upon request.

Duties of the Practice

  • To maintain the privacy of confidential information and to provide required notices pertaining to same .
  • To abide by the terms of the current notice in effect.
  • If terms are changed by practice, revised notice will be sent to you electronically or in paper format .

Complaints: If you believe your privacy rights have been violated, you may file a complaint with the practice (and/or) Secretary of the Department of Health and Human Services by writing to: Secretary of DHHS, 200 Independent Avenue SW, Washington DC 20201 or to Dr.Anandhi Mandi, 4950 NE Belknap Ct #202, Hillsboro OR 97124

Effective Date: September 2012