|
We understand
that information about you and your health is personal. We are committed
to protecting your health information. We create a record of the care and
services you receive at our practice, as well as records regarding payment
for those services. We need these records to provide you with quality
care and to comply with certain legal requirements. This notice applies
to all of the records of your care generated by our practice doctors and
staff.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical
information.
The following categories describe different ways
that we use and disclose health information:
For Treatment.
We may use health information about you to provide you with
medical treatment or services. We may disclose medical information about
you to doctors, nurses, or other personnel who are involved in taking care
of you. Our practice also may share medical information about you in
order to coordinate your care, such as prescriptions and lab work.
For Payment.
We may use and disclose health information about you so that the
treatment and services you receive at our practice may be billed, and that
payment may be collected from you, an insurance company or another third
party. We may also tell your health plan about a treatment you are going
to receive to obtain prior approval or to determine whether your plan will
cover the treatment.
For Health Care Operations.
We obtain services from our insurers or other business associates
such as quality assessment, quality improvement, outcome evaluation,
protocol and clinical guide-lines development, training programs,
credentialing, medical review, legal services, and insurance. We
will share information about you with such insurers or other business
associates as necessary to obtain these services.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
The
health and billing records we maintain are the physical property of the
doctor's office. The information in it, however, belongs to you. You
have a right to:
Request Restrictions.
You have the right to request a restriction or limitation on
the medical information
we use or disclose about
you for treatment, payment, or health care operations purposes. You may
also request a limit on the medical information we disclose about you to
someone who is involved in your care or the payment for your care, like a
family member or friend. We are not required to agree to your
request. If we do agree, we will comply with your request unless
the information is needed to provide you emergency treatment.
Inspect and Copy.
You have the right to inspect and copy medical information that may be
used to make
decisions about your care. Usually, this includes medical and billing
records, but does not include psychotherapy notes. You may exercise this
right by delivering the request in writing to our office using the form we
provide to you. We may charge a fee for the costs of copying, mailing or
other supplies associated with your request. We may deny your request to
inspect and copy in certain limited circumstances. You may request that
the denial be reviewed.
Amend.
You have the right to
request that your health care record be amended to correct incomplete or
incorrect information by delivering a written request to our office using
the form we provide. The physician or
other health care
provider is not required to make such amendments.
You may file a statement of disagreement
if your amendment is denied, and require that the request for amendment
and any denial be attached in all future disclosures of your protected
health information.
A
Paper Copy of This Notice.
You may obtain a paper copy of the Notice of Privacy
Practices for
Protected Health Information ("Notice") by making a request to our office.
Click here for a
Word document copy that is printer friendly.
An
Accounting of Disclosures.
You may request an accounting of disclosures of your health
information as
required to be maintained by law. A form will be provided to you upon
request. An accounting will not include internal uses of information for
treatment, payment, or operations, disclosures made to you or made at your
request, or disclosures made to family members or friends in the course of
providing care. Your request must state a time period which may not start
more than six years in the past and may not include dates before April 14,
2003. The first list you request within a 12- month period will be free.
We may charge you for the costs of additional lists.
Right to Request
Confidential Communications.
You may request that communications of your health
information be
made by alternative means or at an alternative location by delivering the
request in writing to our office using the form we give you upon request.
You may revoke authorizations that you made previously to use or disclose
information except to the extent information or action has already been
taken by delivering a written revocation to our office.
OTHER USES
AND DISCLOSURES
Notification -
Unless you object, we
may use or disclose your protected health information to notify, or assist
in notifying a family member, personal representative, or other person
responsible for your care, about your location, and about your general
condition, or your death.
Communication with Family -
Using our best judgment,
we may disclose to a family member, other relative, close friend, or any
other person you identify, health information relevant to that person's
involvement in your care or in payment for such care if you do not object
or in an emergency.
Health Related Services -
We may contact you to provide you with appointment reminders, with
information about treatment alternatives, or with information about other
health-related benefits and services that may be of interest to you.
As Required By Law -
We will disclose medical information about you when required to do so by
federal, state or local law.
Military and Veterans -
If you are a member of the armed forces, we may release medical
information about you as required by military command authorities. We may
also release medical information about foreign military personnel to the
appropriate foreign military authority.
Workers' Compensation -
If applicable, we may
release medical information about you for workers' compensation or similar
programs.
Public Health -
As required by law, we
may disclose your protected health information to public health or legal
authorities charged with preventing or controlling disease, injury, or
disability.
Abuse and Neglect -
We may disclose your
protected health information to public authorities as allowed by law to
report abuse or neglect.
Health Oversight -
Federal law allows us to
release your protected health information to a health oversight agency for
activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure.
Judicial/Administrative Proceedings -
We may disclose your
protected health information in the course of any judicial or
administrative proceeding as allowed or required by law, with your
consent, or as directed by a proper court order.
Coroners, Medical Examiners and Funeral Directors
- We may release medical information to a coroner or
medical examiner
consistent with applicable law to identify a deceased person or determine
cause of death or to carry out their duties.
Serious Threat to Health or Safety -
To avert a serious threat to health or safety, we may
disclose your protected
health information
consistent with applicable law to prevent or lessen a serious, imminent
threat to the health or safety of a person or the public.
For Specialized Governmental Functions -
We may disclose your protected health information for specialized
government functions
authorized by law such as to Armed Forces personnel, for national security
purposes, or to public assistance program personnel.
Correctional Institutions -
If you are an inmate of a
correctional institution, we may disclose to the institution or its agents
the protected health information necessary for your health and the health
and safety of other individuals.
CHANGES TO
THIS NOTICE
We reserve the right to change this notice. We reserve the right to make
the revised or changed notice effective for medical information we already
have about you as well as any information we receive in the future. We
will post a copy of the current notice in our practice. The notice will
contain on the first page the effective date.
OTHER USES
OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this
notice or the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose medical
information about you, you may revoke that permission, in writing, at any
time. If you revoke your permission, we will no longer use or disclose
medical information about you for the reasons covered by your written
authorization. You understand that we are unable to take back any
disclosures we have already made with your permission, and that we are
required to retain our records of the care that we provided to you.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file a written
complaint with our practice. You may also file a compliant with the
Secretary of the Department of Health and Human Services. You will not be
penalized in any way for filing a complaint.
|
