NOTICE OF PRIVACY POLICIES AND PRACTICES

Siouxland Obstetrics & Gynecology

Effective Date: March 1, 2013

Revised 03/28/2025

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

At Siouxland Obstetrics & Gynecology, PC, we are committed to protecting the privacy and confidentiality of your Protected Health Information (PHI). This Notice of Privacy Practices explains how we collect, use, and disclose your health information. It also outlines your rights regarding your medical records in accordance with the HIPAA Omnibus Rule.

This Notice applies to all PHI as defined by federal regulations.

Understanding Your Health Record & Information

Each time you visit Siouxland OBGYN, PC, a medical record is created. This record includes your symptoms, test results, diagnoses, treatment plans, and ongoing care. Your health information may be used or disclosed to:

  • Plan and manage your medical treatment.

  • Communicate with other healthcare providers involved in your care.

  • Serve as a legal medical record.

  • Process payments from you, your insurance provider, or a third-party payer.

  • Continuously evaluate and improve the quality of care we provide.

  • Comply with state and federal laws requiring disclosure of health information.

Understanding your medical record and how your information is used helps you:

  • Ensure its accuracy.

  • Understand who may access your health information and for what purposes.

  • Make informed decisions when authorizing disclosures.

Your Health Information Rights

Although your medical record is the physical property of Siouxland OBGYN, PC, the information within it belongs to you. You have the right to:

  • Access, inspect, and obtain copies of your medical records, including in an electronic format. A reasonable cost-based fee may apply for supplies and labor.

  • Request an amendment if you believe your records are inaccurate or incomplete (though we may deny requests under certain conditions).

  • Receive an accounting of disclosures of your health information.

  • Request alternative communication methods (e.g., email) or receive correspondence at an alternate location (e.g., P.O. box).

  • Request restrictions on the use and disclosure of your information. While we are not required to grant all requests, we must comply if you request that PHI related to self-paid services not be shared with your health plan.

  • Revoke a prior authorization for the use or disclosure of your health information, except where action has already been taken.

  • Obtain a copy of your health information in paper or electronic format.

Our Responsibilities

Siouxland OBGYN, PC is legally required to:

  • Maintain the privacy of your PHI.

  • Provide you with this Notice of Privacy Practices.

  • Abide by the terms outlined in this Notice.

  • Notify you in writing if we are unable to honor a requested restriction.

  • Accommodate reasonable requests for alternative communication methods or locations.

  • Notify you in writing if your unsecured PHI has been improperly accessed, acquired, used, or disclosed.

We reserve the right to modify our privacy practices and apply changes to all PHI we maintain. Any revisions will be made available to you upon request.

We will not use or disclose your PHI without your written authorization, except as described in this Notice.

Uses & Disclosures of Your Health Information

Treatment

Your medical information may be shared among healthcare professionals involved in your care, including physicians, nurses, and specialists. We use an Electronic Medical Record (EMR) system to securely store and manage your health information. Additionally, we may:

  • Share relevant medical data with future providers for continued care.

  • Access electronic health networks to coordinate treatment.

  • Utilize a prescription hub to review your medication history for safer prescribing.

Payment

To process payments, we may send bills or claims to you, your insurance provider, or a third-party payer. These records may include:

  • Identifying information.

  • Diagnoses and procedures.

  • Medical supplies used during your visit.

Health Care Operations

We use your information to improve care quality, assess outcomes, and ensure efficient medical services.

Business Associates

We may share PHI with third-party business associates contracted to provide services on our behalf (e.g., billing or IT services). These associates are required to safeguard your information.

Notification & Communication

We may use or disclose your information to:

  • Notify a family member, personal representative, or caregiver about your health status.

  • Call, text, or leave voicemail messages for appointment reminders, billing, or other healthcare-related matters.

  • Mail correspondence such as appointment reminders, surveys, or billing statements.

Communication with Family & Friends

Healthcare professionals may, using their best judgment, disclose relevant health information to a family member, close friend, or caregiver involved in your care or payment.

If you bring a family member or friend into the exam room, this is considered implied consent for discussing relevant medical details.

For More Information or to Report a Concern

If you have any questions about this Notice or believe your privacy rights have been violated, you may contact:

Siouxland OBGYN, PC – Privacy Officer

📍 2730 Pierce Street, Ste 201
📍 Sioux City, IA 51104
📞 (712) 277-3141

You may also file a complaint with the U.S. Department of Health and Human Services – Office for Civil Rights. Contact information is available upon request.

⚠ We will not retaliate against you for filing a complaint.