Patient Information & Privacy
Notice of Privacy Practices
Boice-Willis Clinic values your privacy. Please click the link below to access our privacy practices, in order to better understand your rights and how Boice-Willis may use and disclose your medical information.
Understanding the Health Insurance Portability and Accountability Act (HIPAA)
The HIPAA Privacy Regulations provide federal protections and laws for protected health information that Boice-Willis Clinic has about you. These regulations also provide you certain rights to that information when requested. Boice-Willis Clinic has in place appropriate administrative, technical and physical safeguards to protect the privacy of your protected health information. Click here for more information.
Request Medical Records
The HIPAA Privacy Regulations give you the right to inspect, review, and receive a copy of your Boice-Willis Clinic medical records and billing records.
You have the right to access your records. Boice-Willis Clinic may send copies of your records to another provider or health plan as needed for treatment, payment, and health care operations, or as authorized by you.
To request medical records, click the link below to download & print the Authorization to Disclose Protected Health Information Form. Please complete the form in its entirety, and return the form to any BWC location. Your records will be mailed to you by U.S. Mail. You can also request this form at any BWC location or have it mailed to you.
Authorization to Disclose Protected Health Information Form
Formulario de autorización para compartir información médica protegida
Boice-Willis cannot deny you access to your records because you have not paid your medical bills. Boice-Willis can charge a fee for copying and mailing your records.
If you think the information in your medical or billing record is not correct, you can request that Boice-Willis amend the record. Boice-Willis will respond to your request and will amend the information if it is inaccurate or incomplete. If Boice-Willis does not agree to your request, you have the right to submit a statement of disagreement that Boice-Willis must add to your medical record.
Filing a Complaint
Any individual can file a complaint if they think there has been a violation of their privacy rights. We recommend that you file your complaint with Boice-Willis Clinic by using our online complaint form or by calling the Privacy Official at Boice-Willis Clinic to assist you and who will investigate your complaint. You may also file a complaint with the Office of Civil Rights (OCR) using the OCR Complaint Portal.
If you need immediate assistance or help filing a complaint with Boice-Willis Clinic you may contact the Boice-Willis Clinic Privacy Official at 252-937-0432 or firstname.lastname@example.org.
If you need help filing an OCR complaint or have a question about the complaint or consent forms, please e-mail the OCR at OCRmail@hhs.gov or call 1-800-368-1019.
HIPAA PROHIBITS RETALIATION: Under HIPAA, no entity, including Boice-Willis Clinic, may retaliate against you for filing a complaint. You should notify OCR immediately in the event of any retaliatory action.