THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.PLEASE REVIEW IT CAREFULLY.
Dr. Padgett is required by law to maintain a Privacy Notice and abide by the terms of the notice.The following is a list of how your Protected Heath Information may be used by this office.
Dr. Padgett may disclose protected health information about a patient to nurses, lab technicians, pharmacist, hospital, ambulatory surgery center, pathologist, anesthesiologist and other individuals to coordinate different aspects of the patients care.
Dr. Padgett may use or disclose protected health information to third party payers to receive payment for treatment.
For Health Care Operations:
Dr. Padgett may disclose protected health information tho others in connection with quality assurance reviews.
Dr. Padgett may disclose protected health information in connection with contacting the patient to provide an appointment reminder.
Individuals involved in care or payment for care:
Dr. Padgett may disclose protected health information to friends or family members who are involved in the patients’ medical care.
Dr. Padgett may use or disclose protected health information subject to a valid authorization in connection with a research study, journal article or educational program.
As Required by Law or to Avert a Serious Threat to Health or Safety:
Dr. Padgett may be required by law to disclose protected heath information.
Right to Request Restrictions:
You have the right to request restrictions on certain uses and disclosures of protected health information.However, Dr. Padgett is no required to agree to a requested restriction.
Right to Inspect a Copy:
You have the right to inspect and copy information that may be used to make treatment decisions.Dr. Padgett ma charge a reasonable fee for such copies.
Right to Amend:
You have the right o a written request to amend medical information that he or she believes is inaccurate or incomplete.Dr. Padgett may deny the request fi he or she believes the information is accurate and complete.
Right to Request Confidential Communications: Patient may request that Dr. Padgett only communicate with him or her in a certain manner (i.e., mail, email, text or at work).
The Right to an Accounting of Disclosures:
A patient has the right to request an accounting of all disclosures Dr. Padgett made of protected health information related to the patient over reasonable period.Dr. Padgett may charge a reasonable fee for such listings.
Right to Obtain a Paper Copy:
You have the right o obtain a copy of your medical records.You must request the copy in writing with your signature authorizing Dr. Padgett to release your medical records.You must also provide address as to where medical records may be sent.A reasonable fee may be charged including postage.
IF YOU WISH TO RECEIVE ADDITIONAL INFORMATION ABOUT ANY OF THE MATTERS IDENTIFIED IN THE PRIVACY NOTICE OR IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED BY THE OFFICE, PLEASE CONTACT OUR OFFICE AT 405-755-5115.
Dr. Padgett operates at several different facilities, Oklahoma Surgicare being on of them of which she is part owner.If your surgery is scheduled there please provide her with a feedback on the quality of care you receive there.
I hereby authorize the use and disclosure of any information contained in my medical record to my insurance company, referring physician and /or primary care doctor or to any other individual(s) Dr. Padgett feels is indicated in the quality and continuance of care.I understand that information disclosed pursuant to this authorization may be re-disclosed to additional parties and no longer protected.
I understand that I may revoke this authorization at any tie.I further understand that any such revocation does not apply to the extent that persons authorized to use or disclose my health information have already acted in reliance on this authorization.
I understand that I have a right to inspect and to obtain a copy of any information disclosed pursuant to this authorization
I hereby consent to use and disclosure of my personal health information for the purposed of treatment, payment and health care operations.My signature below which indicates that I have been given an opportunity to ask questions before signing.
I understand that I may request restrictions on the uses and disclosures of my health information at any time by written request.I further understand that Dr. Jeanette Padgett is not required to accept my restrictions request.
I understand that after my initial surgery if any surgical revisions are requested there will be subsequent charges by the facility and anesthesiologist.