PATIENT PRIVACY
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner, medical examiner or funeral director consistent with applicable law to allow them to carry out their duties.
Specialized Government Functions. We may release medical information about you for specialized government functions as authorized by law such as to armed forces personnel, for national security purposes, or to public programs personnel.
Your Rights Regarding Medical Information About You
The health and billing records we maintain about you are the property of Tennessee Family Doctors. You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect )with supervision) medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. You may also request an actual copy of these records. We reserve the right to charge a fee for the costs of copying, mailing or other supplies associated with your request. You may exercise this right by delivering a request in writing to our Privacy Officer using the form we provide to you upon your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by McKnight Clinic will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept. You may exercise this right by delivering a request in writing to our Privacy Officer using the form we provide to you upon request. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the medical information kept by McKnight Clinic;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
If your request is denied, you may file a statement of disagreement and require that the request for amendment and any denial be attached in all future disclosures of your medical information.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer using the form we provide to you upon your request. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. An accounting will not include internal uses of information for treatment, payment, or health care operations, disclosures made to you or made at your request or disclosures made to family members or friends in the course of providing care. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.
Right to Request Restrictions. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request restrictions, you must make your request in writing to our Privacy Officer using the form we provide to you upon your request. In your request, you must tell us (1) what information you want to limit (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications. You have the right to request that communication of your health information be made by alternative means or at an alternative location. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. You may exercise this right by delivering a request in writing to our Privacy Officer using the form we provide to you upon your request.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice at any time by making a request at our office. If you want to exercise any of the above rights, please contact our Privacy Officer in person or in writing, during normal business hours. No individual physician, nurse or other employee can agree to restrictions, amendments, or other rights described herein. Only the Privacy Officer can make these amendments. He./she will provide you with assistance on the steps to take to exercise your rights.

Changes To This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. This notice will contain on the last page the effective date.
To Request Information or File a Complaint
If you have questions, would like additional information or want to report a problem regarding the handling of your information, you may contact our Privacy Officer at the following address: 25 Woodbridge , Somerville, TN 38068.
If you believe your privacy rights have been violated, you may file a written complaint at our office by delivering it to the Privacy Officer. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services at the US Department of Health and Human Services, 200 Independence Avenue, SW, Washington DC 20201. We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from MMC. We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Other Uses of Medical Information
Other uses and disclosures besides those identified in this notice will be made only as otherwise authorized by law or with your written authorization which you may revoke except to the extent information or action has already been taken.
Effective Date: April 14, 2003