HIPPA BESTD CLINIC PRIVACY PRACTICES
describes how medical information about you may be used and disclosed and
how you can get access to this information. Please review it carefully.
However, we reserve the right to change the privacy practices described in this notice, in accordance with the law. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, you will receive a revised copy.
Without your written authorization, we can use your health information for the following purposes:
1. Treatment. For example, a clinician may use the information in your medical record to determine which treatment option, such as which type of medication, best addresses your health needs. The treatment selected will be documented in your medical record, so that other health care professionals can make informed decisions about your care.
2. Payment. We do not charge for any service or medication that we provide. We are required by law to include “payment” as a reason, however we are unable to provide a relevant example.
3. Health Care Operations. We may need your diagnosis, treatment, and outcome information in order to improve the quality or cost of care we deliver. These quality and cost improvement activities may include evaluating the performance of your health care professionals or examining the effectiveness of the treatment provided to you when compared to patients in similar situations. In addition, we may want to use your health information for appointment reminders. For example, we may look at your medical record to determine the date and time of your next appointment with us, and then send you a reminder letter to help you remember the appointment.
4. As required or permitted by law. Sometimes we must report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example, we may have to report abuse, neglect, domestic violence or certain physical injuries, or to respond to a court order.
5. For public health activities. We may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death information, information of concern to the Food and Drug Administration, or information related to child abuse or neglect.
6. For health oversight activities. We may disclose your health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
7. For activities related to death. We may disclose your health information to coroners, medical examiners and funeral directors so they can carry out their duties related to your death, such as identifying the body, determining cause of death, or in the case of funeral directors, to carry out funeral preparation activities.
8. For organ, eye or tissue donation. We may disclose your health information to people involved with obtaining, storing or transplanting organs, eyes or tissue of cadavers for donation purposes.
9. For research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research. Such research might try to find out whether a certain treatment is effective in curing an illness.
10. To avoid a serious threat to health or safety. As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to your or the public’s health or safety.
11. For military, national security, or incarceration/law enforcement custody. If you are involved with the military, national security or intelligence activities, or you are in the custody of law enforcement officials or an inmate in a correctional institution, we may release your health information to the proper authorities so they may carry out their duties under the law.
12. For workers’ compensation. We may disclose your health information to the appropriate persons in order to comply with the laws related to workers’ compensation or other similar programs. These programs may provide benefits for work-related injuries or illness.
NOTE: Except for the situations listed above, we must obtain your specific written authorization for any other release of your health information. If you sign an authorization form, you may withdraw your authorization at any time, as long as your withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to our Privacy Officer at 1240 East Brady Street Milwaukee, WI 53202.
Your Health Information Rights
You have several rights with regard to your health information. If you wish to exercise any of the following rights, please contact our Privacy Officer at (414) 272-2144. Specifically, you have the right to:
1. Inspect and copy your health information. With a few exceptions, you have the right to inspect and obtain a copy of your health information.
2. Request to correct your health information. If you believe your health information is incorrect, you may ask us to correct the information. You may be asked to make such requests in writing and to give a reason as to why your health information should be changed. However, if we did not create the health information that you believe is incorrect, or if we disagree with you and believe your health information is correct, we may deny your request.
3. Request restrictions on certain uses and disclosures. You have the right ask for restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. Or, you may want to limit the health information provided to family or friends involved in your care. However, we are not required to agree in all circumstances to your requested restriction.
4. As applicable, receive confidential communication of health information. You have the right to ask that we communicate your health information to you in different ways or places. For example, you may wish to receive information about your health status in a special, private room or through a written letter sent to a private address. We must accommodate reasonable requests.
5. Receive a record of disclosures of your health information. In some limited instances, you have the right to ask for a list of the disclosures of your health information we have made during the previous six years, but the request cannot include dates before April 14, 2003. This list must include the date of each disclosure, who received the disclosed health information, a brief description of the health information disclosed, and why the disclosure was made. We must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and we may not charge you for the list, unless you request such list more than once per year. In addition, we will not include in the list disclosures made to you, or for purposes of treatment, health care operations, national security, law enforcement/corrections, and certain health oversight activities. Since this encompasses all disclosures that we make, an accounting request by a patient may not be granted because there are no disclosures made by the provider that fall within HIPAA’s reporting requirements to the patient.
6. Obtain a paper copy of this notice. Upon your request, you may at any time receive a paper copy of this notice, even if you earlier agreed to receive this notice electronically. This notice is also available on our website www.bestd.org.
7. Complain. If you believe your privacy rights have been violated, you may file a complaint with us and with the federal Department of Health and Human Services. We will not retaliate against you for filing such a complaint. To file a complaint with either entity, please contact our Privacy Officer at (414) 272-2144., who will provide you with the necessary assistance and paperwork.
Again, if you have any questions or concerns regarding your privacy rights or the information in this notice, please contact our Privacy Officer at (414) 272-2144.
BESTD CLINIC WEBSITE PRIVACY
Our postal address is
We can be reached via e-mail at email@example.com or you can reach us by telephone at 414-272-2144
For each visitor to our Web page, our Web server automatically recognizes only the consumer's domain name, but not the e-mail address (where possible). We collect only the domain name, but not the e-mail address of visitors to our Web page, the e-mail addresses of those who communicate with us via e-mail, aggregate information on what pages consumers access or visit. The information we collect is used for internal review and is then discarded, used to improve the content of our Web page.
If you supply us with your postal address on-line you will only receive the information for which you provided us your address. Persons who supply us with their telephone numbers on-line will only receive telephone contact from us with information regarding orders they have placed on-line.
Please provide us with your name and phone number. We will be sure your name is removed from the list we share with other organizations With respect to Ad Servers: We do not partner with or have special relationships with any ad server companies.
From time to time, we may use customer information for new, unanticipated uses not previously disclosed in our privacy notice. If our information practices change at some time in the future we will post the policy changes to our Web site to notify you of these changes and provide you with the ability to opt out of these new uses. If you are concerned about how your information is used, you should check back at our Web site periodically.
Customers may prevent their information from being used for purposes other than those for which it was originally collected by e-mailing us at the above address, calling us at the above telephone number, writing to us at the above address.
Upon request we provide site visitors with access to financial information (e.g., credit card account information) that we maintain about them, unique identifier information (e.g., customer number or password) that we maintain about them, communications that the consumer/visitor has directed to our site (e.g., e-mails, customer inquiries), contact information (e.g., name, address, phone number) that we maintain about them , a description of information that we maintain about them.
Upon request we offer visitors the ability to have inaccuracies corrected in contact information, unique identifiers.
Consumers can have this information corrected by sending us e-mail at the above address, calling us at the above telephone number, writing to us at the above address.
With respect to security: When we transfer and receive certain types of sensitive information such as financial or health information, we redirect visitors to a secure server and will notify visitors through a pop-up screen on our site, We have appropriate security measures in place in our physical facilities to protect against the loss, misuse or alteration of information that we have collected from you at our site.
If you feel that this site is not following its stated information policy, you may contact us at the above addresses or phone number, The DMA's Committee on Ethical Business Practices at firstname.lastname@example.org, state or local chapters of the Better Business Bureau, state or local consumer protection office, The Federal Trade Commission by phone at 202.FTC-HELP (202.382.4357) or electronically at http://www.ftc.gov/ftc/complaint.htm.
The BESTD Clinic is a 501(c)(3) not-for-profit
Copyright © 2012 Brady East STD Clinic. All rights reserved.