Pelvic Health's Responsibilities:
As a healthcare organization, we will do the following:
- Provide your healthcare information to you, your authorized representative who you have designated to us in writing, attending consulting physicians, other healthcare providers who you designate, and to others to the extent necessary for Pelvic Health to carry out its lawful activities. Examples include sending copies of evaluations and progress notes to your physician(s) and including identifying information about you to your insurance company for reimbursement for services provided to you. Unless requested to do so by law or court order, Pelvic Health will not disclose your healthcare information to any others unless we have your informed written authorization.
- Provide your healthcare information to those parties who are responsible for paying your medical bills. This may include your insurance carrier and other third-party payers, including worker's compensation carriers and automotive insurers, if applicable.
- Make reasonable efforts to limit the information we release or request to the minimum necessary to accomplish the intended purpose.
- Provide information to business associates with whom we contract in order to provide you with healthcare services. To protect healthcare information we provide to business associates, we require all business associates to sign Agreements that set forth the safeguards that must be followed regarding the protection of patient records. Examples of business associates include medical record transcriptionists and equipment vendors.
- There are several circumstances where Pelvic Health is either permitted or required by state or regulation to disclose confidential healthcare information to others without your consent. These circumstances may include, but are not limited to the following:
- To governmental authorities as required by statue (for example, we are required to report suspected child or elder abuse/neglect).
- To other individuals when a healthcare professional believes that there is a duty to warn others in order to prevent harm to any individual.
- To state and federal law enforcement agencies.
- We may also disclose your name and license plate number (if known) to local law enforcement agencies if we believe you are impaired and unable to operate a motor vehicle and you do so despite your request not to.
SPECIAL PROTECTIONS:
Confidentiality of Minors' Records:
The child's parent or guardian should determine access to the medical records of a minor child (under the age of 19). However, in rare circumstances a child may be emancipated or may state thats/he does not want her/his parents or guardians to have access to the records. A parent may be denied access to their child's medical records if Pelvic Health has been provided with a certified copy of a court order, indicating that the parent has no legal rights and responsibilities for the child.
Requests to us should be made in writing:
We require that any request to inspect or copy records, for amendments to medical records, request for restrictions on contents or usage of your medical record, requests to revoke consent or authorizations, request for accounting of disclosures, and request for confidential communication with you, be made in writing.
Please contact us if you have any questions or concerns about the confidentiality and security of your medical records or about your rights and our responsibilities. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.
Please call or write:
Pelvic Health
1 Kennedy Drive U3-4
South Burlington, VT 05403
Phone: 802-863-3323
Fax: 802-863-3288