Notice of Privacy Practices

 

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.  "Protected Health Information" includes information such as a name, address, telephone number, medical record number, dates, social security numbers, and photographs.

 

This notice describes how we may use and disclose your protected health information and how you can get access to this information.  It is effective as of April 14, 2003 and we are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to change the content of our notice at any time and the new notice will be effective for all protected health information that we maintain.  We will post the revised notice and you will receive a written copy at a subsequent visit or upon request.  Please review this notice carefully.  If you have any questions about it, our Privacy Contact is:  Carol Lowe, Administrator

 

We may use and disclose your protected health information without your authorization for each of the following purposes: 

 

Treatment:  to provide, coordinate, or manage your health care and any related services by one or more health care providers.  For example, as necessary your protected health information may be disclosed to a home health agency that provides care to you or to other physicians who may be treating you or to whom you have been referred.

 

Payment: to verify eligibility and coverage, obtain payment for your health care services through billing and/or collection activities, and utilization review.  For example, your protected health information may be disclosed to your insurance carrier for a review of the medical necessity of health care services provided. 

 

Health Care Operations:  to support the business activities of our practice such as quality assessment and improvement activities, licensing, auditing functions, and customer service activities.  For example we may use your protected health information to contact you regarding an appointment or health benefits, call you by name in the lobby, complete an appointment follow-up and we may disclose your protected health information among health care providers involved in your care at our facility.  We may also use your protected health information for mailing customer satisfaction surveys and/or facility newsletters.  Your protected health information may be shared with third party "business associates" that perform various activities (e.g., billing, transcription services) for the facility. Whenever an arrangement between the facility and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

 

Public Health & Safety: to avert a serious and imminent threat to your health or safety or the health or safety of others and to control communicable diseases.  For example, we may disclose your protected health information to a person who may have been exposed or may otherwise be at risk of contracting or spreading a communicable disease or condition.  We may disclose your protected health information to a public health agency authorized to oversee the health care system and, in compliance with federal and state laws, to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.  We may also disclose your protected health information to a foreign government agency that is collaborating with the public health authority.

 

Food and Drug Administration: to report adverse medication events and product defects and enable product tracking and/or recalls.

 

Required by Law: to ensure compliance with applicable reporting obligations.  For example, we may disclose your protected health information to the US Department of Health & Human Services and Workers’ Compensation carriers.

 

Legal Proceedings: in response to a court or administrative order, subpoena, discovery request or other lawful purpose.

 

Law Enforcement: to identify and locate a suspect, fugitive, material witness, crime victim, or missing person or as necessary to potentially prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

 

Military and National Security: as deemed necessary by military authorities for lawful intelligence, counterintelligence, and other national security activities.

 

Research: to enhance medical knowledge gained through research that has been approved by an institutional review board.

 

Death and Organ Donation: for identification purposes, determining cause of death, or the performance of other duties by a coroner, medical examiner, or funeral director as authorized by law and for organ donation when applicable. 

 

Other Disclosures

 

With your authorization we may use and disclose your protected health information to promote the continuity of your health care by providing information to family, friends or designated others who have involvement in your health care.  If you are unable to authorize the disclosure of all or part of your protected health information, but emergency or similar circumstances indicate that disclosure would be in your best interest, we may disclose your protected health information to family, friends, or others to the extent necessary to ensure arrangements for your health care coverage.  Efforts to obtain your authorization for the use and disclosure of your protected health care information will be made as soon as reasonably possible after the delivery of emergency care.  We may also disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts.  You may revoke this authorization, at any time, in writing, except to the extent that the facility has already taken actions relying on your authorization.

 

Individual Rights

 

You have the following rights with respect to your protected health information.  You can exercise your rights by presenting a written request to the Privacy Officer.

 

Ø      To request restrictions on certain uses and disclosures of protected health information, including those to disclosures to family members, other relatives, close personal friends, or any other person identified by you.  Your request must state the specific restriction requested and the party to whom you want the restriction to apply.  We are, however, not required to agree to a requested restriction.  If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

Ø      To reasonable requests that we provide confidential communications of protected health information by alternative means or to alternative locations.

Ø      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.

Ø      To have your protected health information amended with an explanation providing the reason it should be amended.  If we deny your right for amendment, you have the right to file a statement of disagreement to be appended to the information you wanted amended.  If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.

Ø      To receive an accounting of disclosures of your protected health information for purposes other than treatment, payment, health care operations, and certain other activities since April 14, 2003.  An accounting of disclosures will include: the date of disclosure, the name of the person or entity to whom the disclosure was made, a description of the information disclosed, and the reason for the disclosure.

 

Complaints

 

If you feel that your privacy protections have been violated, you have the right to file a written complaint with our Privacy Officer or the US Department of Health & Human Services, Office of Civil Rights, without fear of retaliation.  The Privacy Officer will provide you with the address of the US Department of Health & Human Services as needed.

 

 

 

 

 

 

 

                                                                                                                                    Version 1 – 4/14/03