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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.

Uses and Disclosures Treatment: Your health information may be used by staff members or disclosed in other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, you health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health care operations: Your health information may be used as necessary to support the day-to-day activities and management of AllCare Health System, Inc. and it's covered entities. For example, information on the services your received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law enforcement: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.

Victims of abuse, neglect or domestic violence: Your health information may be disclosed if the disclosure is necessary to prevent serious harm to the individual, or other potential victims.

Healthcare oversight: Your health information may be disclosed for oversight activities authorized by law, including audit investigation, inspection, civil, criminal or administrative proceeding or action.

Judicial and administrative proceedings: Your health information may be disclosed in response to requests made in the course of judicial or administrative proceedings.

Decedents: Your health information may be disclosed to coroners and medical examiners for identification of a deceased person or to determine cause of death.

Serious threats to health or safety: Your health information may be disclosed if a reasonable belief that use or disclosure of the information is necessary to prevent or lesson a serious and imminent threat or safety of an individual or of the public.

Specialized government functions: Your health information may be disclosed to various government agencies for application or eligibility purposes.

Workers' Compensation: Your health insurance may be disclosed to comply with workers' compensation and similar laws.

Other uses and disclosures require your authorization: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information Appointment reminders: Your health information may be used by our staff to send you appointment reminders. Information about treatments: Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.

Fund raising: Unless you request us not to, we will use your name and address to support our fund-raising efforts. If you do not want to participate in fund-raising efforts, please check off the following box. [ ] Please do not use my information for fund raising purposes.

Individual Rights You have certain rights under the federal privacy standards. These include: the right to request restrictions on the use and disclosure of your protected health information

  • The right to receive confidential communications concerning your medical condition and treatment
  • The right to inspect and copy your protected health information
  • The right to amend or submit corrections to your protected health information
  • The right to receive an accounting of how and to whom your protected health information has been disclosed
  • The right to receive a printed copy of this notice.

AllCare Health System's Duties: We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.

 Right to Revise Privacy Practices: As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice of any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Request to Inspect Protected Health Information: You may generally inspect or copy the protected health information what we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Medical Secretary or Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

Complaints: If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Privacy Officer AllCare Health Systems, Inc.
4500 S. Garnett, STE 1000
Tulsa, OK 74146


If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
Contact Person: The name and address of the person you can contact for futher information concerning our privacy practices is:

Privacy Officer AllCare Health Systems, Inc.
4500 S. Garnett, STE 1000
Tulsa, Ok 74146 918-628-0989

AllCare Health Systems and it's covered entities reserves the right to modify the privacy practices outlined in the notice.


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