NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can have access to this information. Please review it carefully.
This Notice of Privacy Practices describes how we may use and disclose your protected health information for treatment, payment or health care operations 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 that may identify you, and that relates to your past, present or future physical or mental health or condition and related health care services.
Your Health Information Rights
Although your medical record is the physical property of this practice, you have the right to look at or get a copy of health information about you that we use to make decisions about you. If you request copies, we will charge you fifty to sixty-five cents for each page plus a $15.00 clerical fee. You also have the right to receive a list of all instances where we have disclosed health information about you for reasons other than treatment, payment, or related administrative purposes. If you believe that information is your record is incorrect, you may request that we correct the existing information or add any missing information.
- Maintain the privacy of your health information
- Notify you of our legal obligations and privacy policies with respect to information we collect and maintain about you
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. We will not use or disclose your health information without your authorization, except as described in this notice.
For More Information or to Report a Problem
If you have questions or if you believe your privacy rights have been violated, you can file a complaint with the Office Manager or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
Your health information may be used and disclosed by your physician, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your health information may also be used and disclosed to pay your health care bills and to support the operation of the physician’s practice.
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other members of our office staff will be recorded in your record and used to determine the course of treatment that should work best for you. In addition, we may disclose your protected health information to another physician or health care provider (ie: a specialist or laboratory) who becomes involved in your care.
We will use your health information for payment.
For example: A bill may be sent to you or to an insurance plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations, in order to support the business activities of the physician’s practice.
For example: We may disclose your protected health information to family practice residents who receive training from our physicians. In addition, we will 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.
Business associates: There are some services provided in our organization through contacts with business associates. Examples include billing or collection services. When these services are contracted, however, we require the business associate to sign a written contract to appropriately safeguard your information.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object
Communication with family: Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. 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 of your location or condition.
Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
- If required by law
- To Coroners, Funeral Directors and Organ Donation Services
- To the Food and Drug Administration (FDA) regarding adverse events
- To Workers’ Compensation
- As required by law for Public Health purposes
- A public health authority in cases of abuse or neglect
- To the agents of a correctional institution, should you be an inmate
- The information of individuals who are armed forces personnel may be disclosed for purposes related to military activity
- For National Security purposes
- For law enforcement purposes or in response to a valid subpoena
- To a health oversight agency for activities authorized by law
Effective Date: July 2015
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