Grace Medical Care

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  HIPAA Disclaimer

Notice of Health Information Privacy Practices

Effective date: April 14, 2003
Grace Medical Care


Grace Medical Care is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information or PHI). In providing services to you, we create records of the services and treatments provided. Our documentation is necessary for many purposes, including, but not limited to, ensuring continuity of medical care; supporting that our standards of care are met; communicating with other members of our health care team. Our first concern is for your health and for keeping your health information confidential.

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law to protect the privacy of your health information. HIPAA requires us to provide you with the following information:

  • How we may use and disclose your PHI.
  • Your privacy rights regarding your PHI.
  • Our obligations concerning the use and disclosure of your PHI.

This Notice applies to all the health records created or retained in the Grace Medical Care office, including records from other health care providers. We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that are created or maintained in the past or created or maintained in the future. A copy of the current Notice will be posted in a visible location at all times. You may also request a copy of our most current Notice.

Please Review this Notice. If you have any questions, please contact the Grace Medical Care Privacy Official at 1-800-742-0330.


There are several categories that describe how we will use or disclose health information about you. This Notice describes the general categories your information will be used for and disclosed by your consent to the provision of services to you. There are also times when you must give your authorization to use or disclose your health information. Your health information may be used and/or disclosed in the following ways without your specific authorization:

  • Treatment - We may use health information about you to provide you with healthcare treatment and services. Your health information may be disclosed to the doctors, clinicians, nurses, technicians, volunteers, and other staff who are providing care to you. These healthcare providers include those working in the Grace Medical Care offices, at a hospital if you are hospitalized under our supervision, or at another doctor's office, lab, pharmacy, or other healthcare provider that you are referred to for consultation, diagnostic tests, lab tests, pharmacies, or for other treatment purposes.
  • Payment - All payments are made in cash
  • .
  • Healthcare Operations - Your health information may be used to assist us in managing the office and continuing to provide the highest quality services available to all our patients. 
  • Disclosures Required by Law - We will disclose health information about you only when required to do so by federal, state, or local law. We will attempt, to the best of our legal abilities, to quash any subpoena from governmental agencies for your medical records. We will resist using or disclosing, to the best of our legal abilities, your health information to any investigations, inquiries, etc. 
  • To Avoid a Serious Threat to Your Health or Safety - We may use and disclose health information about you to prevent a serious threat to your health and safety or to the health and safety of others. Your information would only be disclosed to someone able to help prevent the threat. 
  • Public Health Risks - Your health information may be disclosed to public health authorities that are authorized by law to collect information for the purposes of:
      • Maintaining vital records, such as births and deaths
      • Reporting child abuse or neglect
      • Preventing or controlling disease, injury, or disability
      • Notifying a person regarding potential exposure to a communicable disease
      • Notifying a person regarding a potential risk for spreading or contracting a disease or condition
      • Reporting reactions to drugs or problems with products or devices
      • Notifying individuals if a product or device they may be using has been recalled
      • Notifying appropriate government agency(ies) and authority(ies) if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
      • Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance 
  • Health Oversight Activities - We may be required to disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general. We will make every effort to resist any such oversight activities that will disclose your identity. 
  • Lawsuits and Similar Proceedings- We may be required to use and disclose your health information when requested by court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may also be required to disclose your health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute. We will make every effort to legally resist disclosing information about you and we will also notify you prior to disclosing your health information. 
  • Law Enforcement - We may be required to disclose your health information if ordered to do so by a judge in certain situations. These include: 

•  Regarding a crime victim if we are unable to obtain the person's agreement

•  Concerning a death if we believe has resulted from criminal conduct

•  Regarding criminal conduct in our offices

•  In response to a warrant, summons, court order, subpoena or similar legal process

•  To identify/locate a suspect, material witness, fugitive or missing person

•  In an emergency, to report a crime (including the location or victim(s) or the crime, or the description, identity or location of the perpetrator).

We will resist, to the best of our legal abilities, any and all such law enforcement attempts to learn your identity. 

  • Inmates - Your health information may be disclosed to correctional institutions or law enforcement officials if you are an inmate or required to be under the custody of a law enforcement official. Disclosure for these purposes would be required: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals. 
  • Workers' Compensation - We may be required to release your health information for workers' compensation and other similar programs, if you have a claim. 

Minors have all the rights described in this Notice regarding health information relating to reproductive healthcare, except in some states for abortion and in emergency situations or when the law requires reporting of abuse and neglect. In the case of abortion, if a parent consents to your abortion, the parent has all the rights outlined in this Notice. However, if you obtain a judicial bypass of the consent requirement, you have the same rights as an adult regarding the health information related to your abortion. If you are a minor or a person with a guardian obtaining healthcare that is not related to reproductive health, your parent or legal guardian may have the right to access your medical record and make certain decisions regarding the uses and disclosures of your health information.



 You have the following rights regarding the PHI we maintain about you:

  • Confidential Communications - You have the right to request that our staff communicate with you about your health and related issues in a particular manner or at a certain location. An example is requesting that we contact you at home, rather than work. You will be asked to write the method of how we may contact you as part of the paperwork you will be completing as part of the office visit.
  • Restriction Requests - You have the right to request a restriction in our use or disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of you health information, you must make your request in writing to the Grace Medical Care Privacy Official, 1-800-742-0330. Your request must describe the following:
      • The information you wish restricted
      • Whether you are requesting to limit our use, disclosure or both
      • To whom you want the limits to apply.
  • Inspection and Copies - You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and/or copy in certain limited circumstances. If so, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.
  • Amendment - You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for the office. To request an amendment, your request must be made in writing and submitted to the Grace Medical Care Privacy Official, 1-800-742-0330. You must provide us with a reason that supports your request for the amendment. Your request will be denied if you fail to submit your request and the reason for amendment in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the health information kept by or for our office; (c) not part of the of the health information which you would be permitted to inspect and copy; or (d) not created by our staff, unless the individual or entity that created the information is not available to amend the information. 
  • Accounting Disclosures - All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our office has made of your health information for purposes not related to treatment, payment or operations. Use of your health information as part of the routine patient care in our office is not required to be documented. In order to obtain an "accounting of disclosures," you must submit your request in writing to the Grace Medical Care Privacy Official, 1-800-742-0330. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. 
  • Right to a Paper Copy of this Notice - You are entitled to receive a paper copy of our Notice of Health Information Practices. You may ask us to give you a copy of this Notice at any time or you may contact the Grace Medical Care Privacy Official at 1-800-742-0330. 
  • Right to File a Complaint - If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact the Grace Medical Care Privacy Official, 1-800-742-0330. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
  • Right to Provide an Authorization for Other Uses and Disclosures
    Our office will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your health information may be revoked by you at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in your authorization. Please note that in some states we are required to retain records of your care for a specified period of time by law. 

Again, if you have any questions, please contact the Grace Medical Care Privacy Official at 1-800-742-0330.

April 14, 2003

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