Privacy Policy
IS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
This Notice of Privacy Practices describes how we may use and disclose your
protected health information (PHI) to carry out treatment, payment or health
care operations (TPO) and for other purposes that are permitted or required by
law. It also describes your rights to access and control your protected health
information. “Protected health information” is information about you, including
demographic information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related health care
services.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician,
our office staff and others outside of our office that are involved in your care
and treatment for the purpose of providing health care services to you, to pay
your health care bills, to support the operation of the physician’s practice,
and any other use required by law .
Treatment: We will use and disclose your protected
health information to provide, coordinate, or manage your health care and any
related services. This includes the coordination or management of your health
care with a third party. For example, we would disclose your protected
health information, as necessary, to a home health agency that provides care
to you. For example, your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician has the necessary
information to diagnose or treat you.
Payment: Your protected health information will be
used, as needed, to obtain payment for your health care services. For example,
obtaining approval for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain approval for the
hospital admission.
Healthcare Operations: We may use or disclose, as-needed,
your protected health information in order to support the business activities
of your physician’s practice. These activities include, but are not limited to,
quality assessment activities, employee review activities, training of medical
students, licensing, and conducting or arranging for other business activities.
For example, we may disclose your protected health information to medical school
students that see patients at our office. In addition, we may use a sign-in sheet
at the registration desk where you will be asked to sign your name and indicate
your physician. We may also call you by name in the waiting room when your physician
is ready to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment.
We may use or disclose your protected health information in the following
situations without your authorization. These situations include: as Required
By Law, Public Health issues as required by law, Communicable Diseases: Health
Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal
Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation:
Research: Criminal Activity: Military Activity and National Security: Workers’
Compensation: Inmates: Required Uses and Disclosures: Under the law, we must
make disclosures to you and when required by the Secretary of the Department
of Health and Human Services to investigate or determine our compliance with
the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be
Made Only With Your Consent, Authorization or Opportunity to Object unless required
by law.
You may revoke this authorization, at any time, in writing,
except to the extent that your physician or the physician’s practice has taken
an action in reliance on the use or disclosure indicated in the authorization.
Your Rights
Following is a statement of your rights with respect to your protected health
information.
You have the right to inspect and copy your protected health information. Under
federal law, however, you may not inspect or copy the following records; psychotherapy
notes; information compiled in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health information
that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health
information. This means you may ask us not to use or disclose any
part of your protected health information for the purposes of treatment, payment
or healthcare operations. You may also request that any part of your protected
health information not be disclosed to family members or friends who may be involved
in your care or for notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction requested and to
whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request.
If physician believes it is in your best interest to permit use and disclosure
of your protected health information, your protected health information will
not be restricted. You then have the right to use another Healthcare Professional.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location. You
have the right to obtain a paper copy of this notice from us, upon
request, even if you have agreed to accept this notice alternatively i.e. electronically.
You may have the right to have your physician amend your protected
health information. If we deny your request for amendment, you have
the right to file a statement of disagreement with us and we may prepare a rebuttal
to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information.
We reserve the right to change the terms of this notice and will inform you
by mail of any changes. You then have the right to object or withdraw as
provided in this notice.
Complaints
You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint
with us by notifying our privacy contact of your complaint. We will
not retaliate against you for filing a complaint.
This notice was published and becomes effective on/or before April
14, 2003.
We are required by law to maintain the privacy of, and provide individuals
with, this notice of our legal duties and privacy practices with respect to protected
health information. If you have any objections to this form, please ask to speak
with our HIPAA Compliance Officer in person or by phone at our Main Phone Number.
|
