Your/Your Child's Rights Regarding Your Child's PHI
You have the following rights regarding PHI Christine maintains about yourself/your child. To exercise any of these rights, please submit your request in writing to her:
Right of Access to Inspect and Copy
You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that may be used to make decisions about your/your child's care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would be reasonably likely to endanger the life or physical safety of you, another person, or your child. She may charge a reasonable, cost-based fee for copies and will act on your request within 30 days of receiving your request.
Right to Amend
If you feel the PHI Christine has about you/your child is incorrect or incomplete, you may ask her in writing to amend the information, although she is not required to agree to the amendment.
Right to an Accounting of Disclosures
You have the right to request an accounting of the disclosures Christine makes of your child's PHI. This is a list of certain disclosures she has have made of your/your child's PHI. To make this request, you should submit it in writing to her. She may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information Christine uses or disclosures about you/your child for treatment, payment, or health care operations. For example, you might request particularly sensitive information, such as the existence of drug dependence, not be disclosed for any purpose. She is not required to agree to your request. To request restrictions, you must submit your request in writing to her. In your request, you must tell her (1) what information you want to limit, (2) whether you want to limit the use, disclosure, or both, and (3) to whom you want the limits to apply (for example, disclosures to your insurance carrier.)
Right to Request Confidential Communication
You have the right to request she communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that she only contact you at work or by mail.
Right to a Copy of this Notice
You have the right to a paper copy of this notice. You may ask her to give you a copy of this notice at any time.
If you believe Christine has violated your or your child's privacy rights, you have the right to file a complaint in writing with her or the Office for Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building — Room 1875, Boston, Massachusetts 02203. She will not retaliate against you for filing a complaint.