Patient Information Protection Plan

This notice describes how medical information about you may be used and disclosed and about how you can get access to this information.  Please review it carefully.


The Patient Information Protection Plan covers individually identifiable personal health, financial and demographic information (known as Protected Health Information or PHI) created or maintained by this practice. We are required to provide patients with this notice of our obligations and privacy practices.  Federal law requires we protect PHI and allows for its use to carry out treatment, payment, or other health care operations (TPO).


Treatment refers to those activities required to provide quality patient care, and includes discussion of PHI with staff when necessary, sharing medical information with hospitals, diagnostic services or specialists, and sharing prescribing data with pharmacies and prescribing networks.  Payment refers to obtaining payment or reimbursement, determining eligibility or coverage, and other billing activities.  These activities often involve third parties such as your insurance company, a third party administrator (TPA) designated by your insurance company, or a billing service we may contract with.  Other Healthcare Operations include authorizing referrals to other providers; utilization reviews conducted by your health plan; or quality or performance reviews and surveys conducted by ourselves, our agents, or other health care providers.


TPO disclosures will include all pertinent medical information to other health care providers for treatment purposes and to insurers or third party administrators (TPA) when required to process claims.   Patients may request to withhold information from their health plan or TPA if they have paid in full for their treatment or service.  Montgomery Family Medicine will communicate results, directions, and reminders to patients via mail, telephone or electronic means.  This communication is vital to our provision of good and complete healthcare and we will take reasonable precautions to protect PHI.


It is the policy of this practice to protect your privacy and not to permit the disclosure of PHI for any non-routine or remunerated reasons without expressed written and revocable authorization from the patient that must include the nature, time frame and receiver of the data to be released.  Non-routine disclosures are those for other then TPO and include patient mailing lists to third parties for commercial purposes and information to an employer for employment decisions.  The practice must disclosure PHI when required by law or in the interest of public health.  Patients will be notified in writing of any breach of their unsecured PHI.


All employees are counseled on the importance of confidentiality and discuss PHI only to the extent required to carry out TPO.  PHI is used or accessed only on a need to know basis.  PHI is stored electronically and in paper charts.  The Administrator is responsible for ensuring compliance with, and training on, the Patient Information Protection Plan.  Questions or concerns may be addressed to him by calling our office at (334) 396-9100.  Montgomery Family Medicine reserves the right to change this policy and is required to abide by the most current version.  The current version is posted and available in our lobby and posted on our web site.  Possible violations of rights listed here may be reported, without adverse consequence, to the Administrator at the above number or to the Secretary of HHS.


Notice of Individual Rights

Patients are encouraged to read this notice and will be provided a copy if they desire.  When giving reasonable, written notice, patients have the right to review health information, amend incomplete or inaccurate records, request alternative methods for communicating PHI, request an accounting of PHI disclosures, know who has accessed PHI for non-routine reason, and request special accommodations and restrictions on the use of PHI for TPO.  Montgomery Family Medicine is not obligated to agree to any special restrictions and will not agree to any that unreasonably hampers the provision of TPO.  Only an officer of the practice may agree to restrict the use of PHI or change how it is normally used.


Effective Date: 10/17/02     Revision Date: 11/19/15