Your Information. Your Rights. Our Responsibilities. 

This notice is in accordance with HIPAA and 45 CFR §164.520 and describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Information

Dr. Shandi Fuller may collect data through a variety of means, including, but not limited to online submissions, email, phone, etc. that are either required by law or necessary for patient onboarding. 

Financial and/or medical information that you provide in writing, online, over the phone (including information left on voicemails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.

We do not exchange, sell, or widely disseminate any information about patients who inquire about or receive our services. Such information is considered protected health information and is confidential. We will only share your information in the following circumstances:

 

• To provide continuing care or treatment

• As allowed by a signed Release of Information Authorization

• As required by law

• In the interest of public health or safety

 

In all other cases, your personal health information is only used as is reasonably necessary to provide you with health services. Provision of such services may require communication between Dr. Fuller and other health care providers, pharmacies, billing agencies, and others as necessary to verify your medical information is accurate and determine the type of services you need.

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.

Minor Patients & Guardians

Dr. Fuller is committed to protecting the privacy of minor patients.  Minor patient information will be managed with the same confidentiality as mentioned above. However, minor protected health information may be provided to parents, guardians, and adult members of the child’s household unless a specific request NOT to do so is made in writing. 

We may disclose minor protected health information to a government authority if we believe that you or your child has been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Note: All forms related to treatment, privacy, and authorization for third-party disclosure for the purpose of treatment must be signed by a parent or guardians. 

Your Rights

All patients have the right to: 

 

• 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. 

  • 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 tell you 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 say “yes” to all reasonable requests.

• Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment. We will say “yes” unless a law requires us to share that information.

• Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) 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, and certain other disclosures (such as any you asked us to make). 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 paper copy of this notice at any time, even if you have agreed to receive the notice electronically. 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 we have violated your rights, please contact us immediately at Phone or Email.

  • You can also 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.

  • We will not retaliate against you for filing a complaint.

 

Our Responsibilities

 

• 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 give 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. 

• All information entered on our website is stored on a secure database.

 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

This Notice of Privacy Practices is effective as of March 2020, and, was last updated on April 29, 2022.