OBGYN of Fairfield County Connecticut

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Privacy Statement

NOTICE OF PRIVACY

Ø                  Law Enforcement  We may disclose your protected health information for certain law enforcement purposes, including, but not limited to:

·                     In response to a court order, subpoena, warrant, summons or similar process;

·                     To identify or locate a suspect, fugitive, material witness, or missing person;

·                     About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;

·                     About a death we believe may be the result of criminal conduct;

·                     About criminal conduct at the hospital; and

·                     In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Ø                  Coroners, Medical Examiners and Funeral Directors, Organ/Tissue Donation Organization  We may release protected health information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release protected health information to funeral directors as necessary to carry out their duties. If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

ANY OTHER USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION REQUIRES YOUR WRITTEN AUTHORIZATION

Under any circumstances other than those listed above, we will request that you provide us with a written and signed authorization before we use and disclose your protected health information to anyone.

If you sign an authorization allowing us to disclose protected health information about you, in a specific situation, you can later revoke (cancel) your authorization in writing.

If you cancel your authorization in writing, we will not disclose your protected health information about you after we receive your cancellation, except for disclosures, which were already being processed or made before we received your cancellation.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

You have the following rights regarding protected health information we maintain about you:

 

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