Northwest Arkansas EMG Clinic

NOTICE OF PRIVACY PTRACTICES (PDF)

Notice of Privacy Policy

Communications. You can request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact your home, rather than your work.  We will accommodate reasonable requests.

You can request a restriction in our use or disclosure of your health information for treatment, payment, or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care, or the payment of your care, such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound to our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.

You have the right to inspect and to obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to: 

The Privacy Officer @ Northwest Arkansas EMG Clinic.  There will be a $5.00 charge for the medical records requested by the patient and should be paid at the time of the request.

You may ask to amend your health information if you believe it is incorrect or incomplete, as long at the information is kept by, or for our practice.  To request an amendment, your request must be in writing and submitted to: The Privacy Officer @ Northwest Arkansas EMG Clinic.  You must provide us with a reason that supports your request for amendment.

Right to a copy of this notice.  You are entitled to receive a copy of this Notice of Privacy Practices.  You may ask us to give you a copy of this Notice at any time.  To obtain a copy of this Notice, contact our front desk receptionist.

Right to file a complaint.  If you believe your privacy rights have been violated, you may file a complaint with our practice, or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact: The Privacy Officer @ Northwest Arkansas EMG Clinic.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

Right to provide an authorization for other uses and disclosures.  Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

If you have any questions regarding this notice or our health information policies, please contact:                                   

Northwest Arkansas EMG Clinic
Miles M. Johnson, M.D.
c/o The Privacy Officer
PO Box 9450
Fayetteville, AR 72703