Christensen Foot & Ankle



Christensen Foot & Ankle Clinic

1777 E. Clark St. Suite 220

Pocatello, ID 83201

Phone: (208) 235-1777                Fax: (208) 232-7518


Effective Date: 1/1/2017




A. How This Medical Practice May Use or Disclose Your Health Information


This medical practice collects health information about you and stores it in

an electronic health record. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:


  1. Treatment

We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or other health care providers who will provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test. We may also disclose medical information to members of your family or others who can help you when you are sick or injured, or after you die.


  1. Payment

We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.


  1. Health Care Operations

We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you.


  1. Notification and Communication With Family

We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about y our location, your general condition or unless you had instructed us otherwise, in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. We may also disclose information to someone who is involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although we may disclose this in

formation in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.


B. Your Health Information Rights


  1. Right to Request Special Privacy Protections

You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed.


  1. Right to Request Confidential Communications

You have the right to request that you receive your health information in a specific way or at a specific location.


  1. Right to Inspect and Copy

You have the right to inspect and copy your health information with limited exceptions.


  1. Right to Amend or Supplement

You have a right to request that we amend your health information that you believe is incorrect or incomplete.


  1. Right to an Accounting of Disclosures

You have a right to receive an accounting of disclosures of your health information made by this medical practice


  1. Right to a Paper or Electronic Copy of this Notice

You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices


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