Cheyenne Health and Wellness Center (CHWC)
strives to provide quality health care services to all those in
need, with integrity and respect, in a caring environment.
CHWC accepts all patients regardless of their ability
to pay for services. To ensure that income or lack of insurance
is not a barrier to care, low income patients who are not covered
by public or private insurance are charged on a sliding fee scale.
Cheyenne Health & Wellness
Notice of Privacy Practice
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY GET USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
CONFIDENTIALITY OF HEALTH INFORMATION
This Notice of Privacy Practice describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment of health care operations, and for the purposes required by law. Any information concerning a patient’s condition, treatment, personal affairs, or records, whether hard copy, computerized or stored in other media, shall be kept confidential. Such information may be released only through or with the approval of an individual or when compelled to do so pursuant to legal process or when applicable by law.
DISCLOSURE OF HEALTH INFORMATION
The Cheyenne Health and Wellness Center (CHWC) is committed to providing only the best possible health care to our patients. It will be necessary to use or disclose your protected health information (PHI) to various entities in order to provide you with the highest quality of care available. Disclosures will be made to providers, staff, and other entities for the purpose of treatment, payment, and health care operations.
OTHER DISCLOSURES
Any uses of PHI, other that the Disclosure of Health information listed will require CHWC to obtain written or oral authorization from an individual or his/her representative. In accordance to regulation 164.508(b)(5), an individual or their legal representative has the right to revoke this authorization at any time; the revocation of the authorization must be done in writing except to the extent that:
The clinic has taken action thereon; or
If the authorization was obtained as a condition of obtaining insurance coverage.
PATIENT RIGHTS
Patients of CHWC have the right to request restriction to uses and disclosures of protected health information, which include:
Uses or disclosures of PHI about the individual to carry out treatment, payment, and health care operations.
Uses or disclosures of PHI to family members, other relatives, or close friends of the individual, or any other individuals identified by an individual.
CHWC is not required to agree to the request to restrict protected health information per regulation 164.522(ii). We will however make every reasonable effort to accommodate our patients wishes based upon our professional experience.
>An individual may request restrictions on the use and disclosure of his/her PHI by:
A) Notify the staff at CHWC in writing of your wish to limit disclosure of your PHI.
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