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Notice
of Privacy Practices
This
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.
Protected health information, about you, is maintained as a record of
your contacts or visits for healthcare services with our clinic. Specifically, "protected
health information" is information about you, including demographic
information (i.e., name, address, phone, etc.), that may identify you
and relates to your past, present or future physical or mental health
condition and related health care services.
We are required to follow specific rules on maintaining the confidentiality
of your protected health information, using your information, and disclosing
or sharing this information with other healthcare professionals involved
in your care and treatment. This Notice describes your rights to access
and control your protected health information. It also describes how
we follow applicable rules and use and disclose your protected health
information to provide your treatment, obtain payment for services you
receive, manage our health care operations and for other purposes that
are permitted or required by law. If you have any questions about this
Notice, please contact our Privacy Manager.
Your Rights Under The Privacy Rule
Following is a statement of your rights, under the Privacy Rule, in reference
to your protected health information. Please feel free to discuss any
questions with our staff.
You have the right to receive, and we are required
to provide you with, a copy of this Notice of Privacy
Practices - We are required to follow the terms
of this notice. We reserve the right to change the terms
of our notice, at any time. If needed, new versions of
this notice will be effective for all protected health
information that we maintain at that time. Upon your
request, we will provide you with a revised Notice of
Privacy Practices if you call our office and request
that a revised copy be sent to you in the mail or ask
for one at the time of your next appointment.
You have the right to authorize other use and
disclosure - This means you have the right to
authorize or deny any other use or disclosure of protected
health information that is not specified within this
notice. You may revoke an authorization, at any time,
in writing, except to the extent that your health care
provider or our office has taken an action in reliance
on the use or disclosure indicated in the authorization.
You have the right to designate a personal representative -
This means you may designate a person with the delegated
authority to consent to, or authorize the use or disclosure
of protected health information.
You have the right to inspect and copy your protected
health information - This means you may inspect
and obtain a copy of protected health information about
you that is contained in your patient record.
You have the right to request a restriction of
your protected health information - This means
you may ask us, in writing, 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. In
certain cases, we may deny your request for a restriction.
You have the right to request an amendment to
your protected health information - This means
you may request an amendment of your protected health
information for as long as we maintain this information.
In certain cases, we may deny your request for an amendment.
You have the right to request disclosure accountability -
This means that you may request a listing of disclosures
that we have made, of your protected health information,
to entities or persons outside of our office other than
for the purposes of treatment, payment, healthcare operations,
or a purpose authorized by you.
How We May Use or Disclose Protected Health
Information
Following are examples of uses and disclosures of your protected health
care information that we are permitted to make.
Treatment - We may 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 that is involved in your
care and treatment. For example, we would disclose your
protected health information, as necessary, to a pharmacy
that would fill your prescriptions. We will also disclose
protected health information to other healthcare providers
who may be involved in your care and treatment. We may
also call you by name in the waiting room when your healthcare
provider 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 contact
you by phone or other means to provide results from exams
or tests and to provide information that describes or
recommends treatment alternatives regarding your care.
Also, we may contact you to provide information about
health related benefits and services offered by our office.
Payment - Your protected health information
will be used, as needed, to obtain payment for your health
care services. This may include certain activities that
your health insurance plan may undertake before it approves
or pays for the health care services we recommend for
you such as; making a determination of eligibility or
coverage for insurance benefits, reviewing services provided
to you for medical necessity, and undertaking utilization
review activities.
Healthcare Operations - We may use or
disclose, as-needed, your protected health information
in order to support the business activities of our practice.
This includes, but is not limited to business planning
and development, quality assessment and improvement,
medical review, legal services, and auditing functions.
It also includes education, provider credentialing, certification,
underwriting, rating, or other insurance-related activities.
Additionally, it includes business administrative activities
such as customer service, compliance with privacy requirements,
internal grievance procedures, due diligence in connection
with the sale or transfer of assets, and creating de-identified
information.
Other Permitted and Required Uses and Disclosures
We may also use and disclose your protected health information in the
following instances as outlined below. You have the opportunity to agree
or object to the use or disclosure of all or part of your protected health
information,
To Others Involved in Your Healthcare -
Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person,
you identify, your protected health information that
directly relates to that person's involvement in your
health care. If you are unable to agree or object to
such a disclosure, we may disclose such information as
necessary if we determine that it is in your best interest
based on our professional judgment. We may use or disclose
protected health information to notify or assist in notifying
a family member, personal representative or any other
person that is responsible for your care, general condition
or death. If you are not present or able to agree or
object to the use or disclosure of the protected health
information, then your physician may, using professional
judgment, determine whether the disclosure is in your
best interest. In this case, only the protected health
information that is relevant to your health care will
be disclosed.
As Required By Law - We may use or disclose your protected health
information to the extent that the use or disclosure is required by law.
For Public Health - We may disclose
your protected health information for public health activities
and purposes to a public health authority that is permitted
by law to collect or receive the information.
For Communicable Diseases - We may disclose
your protected health information, if authorized by law,
to a person who may have been exposed to a communicable
disease or may otherwise be at risk of contracting or
spreading the disease or condition.
For Health Oversight - We may disclose protected health information
to a health oversight agency for activities authorized by law, such as
audits, investigations, and inspections.
In Cases of Abuse or Neglect - We may
disclose your protected health information to a public
health authority that is authorized by law to receive
reports of child abuse or neglect. In addition, we may
disclose your protected health information if we believe
that you have been a victim of abuse, neglect or domestic
violence to the governmental entity or agency authorized
to receive such information. In this case, the disclosure
will be made in a manner that is consistent with the
requirements of applicable federal and state laws.
To The Food and Drug Administration -
We may disclose your protected health information to
a person or company required by the Food and Drug Administration
to report adverse events, to monitor product defects
or problems, to report biologic product deviations, to
track products; to enable product recalls; to make repairs
or replacements, or to conduct post-marketing surveillance,
as required.
For Legal Proceedings - We may disclose
protected health information in the course of any judicial
or administrative proceeding, in response to an order
of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request
or other lawful process.
To Law Enforcement - We may also disclose
protected health information, as long as applicable legal
requirements are met, for law enforcement purposes.
To Coroners, Funeral Directors, and Organ Donation -
We may disclose protected health information to a coroner
or medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner
to perform other duties authorized by law. We may also
disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral
director to carry out his/her duties. Protected health
information may be used and disclosed for cadaveric organ,
eye or tissue donation purposes.
In Cases of Criminal Activity - Consistent
with applicable federal and state laws, we may disclose
your protected health information, if we believe that
the use or disclosure is necessary to prevent or lessen
a serious and imminent threat to the health or safety
of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement
authorities to identify or apprehend an individual.
For Military Activity and National Security -
When the appropriate conditions apply, we may use or
disclose protected health information of individuals
who are Armed Forces personnel (1) for activities deemed
necessary by appropriate military command authorities;
(2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits,
or (3) to foreign military authority if you are a member
of that foreign military service.
For Workers' Compensation - Your protected
health information may be disclosed, by us as authorized
to comply with workers' compensation laws and other similar
legally- established programs.
When an Inmate - We may use or disclose
your protected health information if you are an inmate
of a correctional facility and your physician created
or received your protected health information in the
course of providing care to you.
Required Uses and Disclosures - Under the law, we must make
disclosures about 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 the Privacy Rule.
Complaints
You may address complaints 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 Manager of
your complaint.
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