Patient Privacy, Responsibilities & Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. This is a summary of the Notice of Privacy Practices. Read the full version to sign the acknowledgment. I understand that, under the Health Insurance Portability Act of 1996 (HIPAA), I have certain rights to privacy regarding my Individually Identifiable Health Information (IIHI). I understand that this information can and may be used for:

  • Treatment
  • Payment for treatment or services
  • Healthcare operations
  • Appointment/Follow-up calls
  • Coordinating healthcare care among individuals involved in your or your child(ren)’s care

I understand that my or my child’s PHI may be disclosed to outside individuals if:

  • Required by court order, law enforcement, and/or public health organizations
  • Assisting to prevent or control disease, injury, or disability in matters of public health
  • Assisting to avert a serious threat to the health or safety of you, or any other person or the public
  • Assisting funeral directors, medical examiners, or coroners in the event of death
  • Assisting in organ/tissue donations if your child is an organ donor
  • For approved research purposes; patient identification will only be released with your permission
  • Required by federal officials in matters of national security
  • Recommending possible treatment alternatives
  • Complying with Workers’ Compensation cases

I understand that I have the right to:

  • Request a restriction on the use and disclosure of my or my child’s health record
  • Request to inspect or obtain a copy of the child’s health record
  • Request to correct or amend information in the child’s health record
  • Request confidential communications
  • Receive a paper copy of this notice

Howard University Faculty Practice Plan will not receive payment or other compensation from a third party in exchange for using or disclosing the Notice of Privacy Practices. I do not have to sign this authorization in order to receive treatment from Howard University Faculty Practice Plan. I acknowledge that I have the right to refuse to sign this authorization notice. I have read the full version of the Notice of Privacy Practices. When my information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure by the recipient and may no longer be protected by the federal HIPAA Privacy Rule. I have the right to revoke this authorization in writing except to the extent that Howard University Faculty Practice Plan has acted in reliance upon this authorization. My written revocation must be submitted to Howard University Faculty Practice Plan at 2041 Georgia Ave, Patient Grievances Suite 5100, Washington DC 20059.

Bioethics Committee

The hospital’s Bioethics Committee is available to help you or your family deal with issues related to the appropriateness of care and end-of-life decisions. To request a Bioethics consult, you or a member of your family may call the Medical Staff Office at 202-865-6702.