THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.
YOU HAVE READ AND UNDERSTAND THIS POLICY. OUR COMMITMENT
TO YOUR PRIVACY:
Our Commitment to Your Privacy:
Protection of a patient’s private health information is a matter of
great importance to us. Our practice is
dedicated to maintaining the privacy of your medical information. In conducting our business, we will create
records regarding you and the treatment and services we provide for you. We are required by law to provide you with
this notice of our legal duties and privacy practices that we maintain in our
practice. This notice outlines the
federal regulations for maintaining the privacy of your medical records.
HOW
WE MAY USE AND DISCLOSE HEALTH INFORMATION:
There are certain instances that we may use and disclose health information without an authorization. These are stated as follows:
* We may use and disclose health information for your treatment and to provide you with treatment-related services. For example
we may disclose health information to doctors, nurses, technicians, or other personnel (including people outside our office), who are involved in your medical care.
· We will use and disclose your health information to provide, coordinate, or manage your health care and any related services, eg coordination of care with your referring physician.
· Your health information will be used, as needed, to obtain payment for your health care services. Including, but not limited to activities your health insurance may undertake before it approves or pays for the health care services we recommend for you.
· As required to support the business activities of this clinic. These activities include, but are not limited to, quality assessment activities, employee review activities, training of health care professionals, licensing, and credentialing.
· This clinic may contact you to make appointment reminders
·
We may also contact you regarding treatment
alternatives or other health-related benefits and services that may be
available.
Special Situations We are Required to Release Health Information
· As required by Law We will disclose health information when required to do so by international, federal, state or local law.
· Public Health Risks A public health authority that is authorized by law to collect or receive information for the purpose of preventing or controlling disease, injury, or disability; including, but not limited to the report of birth or death.
·
To Avert
a Serious Threat to Health or Safety.
A public health authority or other appropriate government authorized by
law to receive reports of child abuse or neglect. A government authority, including a social
service or protective services agency, authorized by law to receive such
reports, on neglect or domestic violence.
·
Government
Activities. The Food and Drug Administration to report adverse events,
product defects or problems, enable product recalls, repairs, or replacement.
* Worker’s Compensation. An employer, about an individual who works under the employer, if:
*The clinic provides service to the individual at the request of the employer to evaluate work-related illness or injury
*The clinic finds a work-related illness or injury
· Health Oversight Activities. To a health oversight agency for activities authorized by law, including audits, civil, administrative, or criminal investigations or proceedings, inspections, licensure, or disciplinary actions or other activities necessary for oversight of the health care system; government benefits programs for which health information is relevant to eligibility, government regulatory programs for which health information is necessary for determining compliance with program standards.
o NOTE: Health oversight activities investigations only pertain to the receipt of health care, a claim for public benefits related to health.
· Lawsuits & Disputes. In response to an order of court, subpoena, court-ordered warrant, discovery request or other lawful process.
· Business Associates. To perform functions on our behalf or provide us with services if the information is necessary for such functions or services, for example, transcription services and/or billing services. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information. The Business Associates abide by the same rules, regulations and laws.
·
Coroners,
Medical Examiners, and Funeral Directors.
To identify a deceased person or as necessary for their duties.
·
National
Security and Intelligence Activities. To
authorized federal officials for intelligence, counter-intelligence, and other
national security activities authorized by law.
For protection to the President, other authorized persons, or foreign
heads of state, or to conduct special investigations.
·
Inmates
or Individuals in Custody. If you
are an inmate of a correctional institution or under the custody of a law
enforcement official, we may release information to the correctional
institution or law enforcement official, This release would be necessary:
*For the institution to provide you with health care
*To protect your health and safety or the health and safety of others
*For the safety and security of the correctional institution
· Law Enforcement. For law enforcement purposes, as required by law that require the reporting of certain types of wounds or other physical injuries, in information sought is relevant and material to a legitimate law enforcement inquiry.
* Limited information may be released for the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
*To law enforcement official for information needed to determine whether a violation of law by a person, other than the victim, has occurred and such information is not intended to be used against the victim
*To a law enforcement official if the professional believes in good faith the evidence constitutes criminal conduct that occurred on the premises of the clinic.
*The clinic may disclose information of a patient who has died to a law enforcement official if the clinic believes that such death was the result of criminal conduct.
YOUR RIGHTS:
YOU HAVE THE FOLLOWING RIGHTS WHEN IT COMES
TO YOUR PERSONAL HEALTH INFORMATION AND HOW THIS INFORMATION IS MAINTAINED.
·
Right to
request restriction’s. You have the
right to request a restriction or limitation on your personal health
information we use to carry out treatment, payment or healthcare
operations. You also have the right to
request a limit on the health information we disclose to someone involved in
your care, like a family member or friend, E.g.: We will not disclose information about you to
your spouse unless a written request is received. We are not required to agree to your request. If
we agree, we will comply with your request unless the information is needed to
provide emergency treatment or unless required to release information as
required by law. If you would like to
terminated a restriction, it must be in writing and given to the receptionist.
·
Right to
inspect and obtain a copy. You have the right to inspect and copy
health information that may be used to make decisions about your care or
payment for your care. This includes
medical billing records. To inspect and
copy this health information, you must make your request by completing the
appropriate form obtained from the receptionist. The exceptions to inspecting and copying are:
o Psychotherapy
notes
o Medical
information created by another physician
o Information
created in reasonable anticipation of use in a civil, criminal, or
administrative action or proceeding
o The
personal health information created by the provider acting under the directions
of a correctional institution
o If
the healthcare provider has determined that access is reasonably likely to
endanger the patient’s life or physical safety or the life or physical safety
of another person
· Right to request confidential communication. You have the right to request alternative means of communication with you about medical matters. For example, you may request that we only contact you at work or not leave messages on your answering machine, To request alternative communication complete the “alternative communication” form you can request from the receptionist. Your request must include specifically how or where you wish to be contacted. The request will be reviewed and we will accommodate reasonable requests.
· Right to amend. If you feel that the health information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment if the information requested was created by our office. You may request this by completing an amendment form provided by the receptionist. The clinic has certain right to deny this request if the information was not created by our clinic
· Right to an accounting of disclosures. You have the right to request a list of certain disclosures we made of your health information. To request an accounting please notify the receptionist for an accounting log. The exception to an account is:
o To receive payment, treatment or operations
o For National security or intelligence purposes
o To correctional institutions or enforcement officials
o That occurred before April 2003
CHANGES TO THIS NOTICE
We reserve the right to
change this notice and make the new notice apply to the information we already
have as well as information received in the future. A copy of the current notice will be posted
with the new effective date.
COMPLAINTS
If you feel your privacy
rights have been violated according to this notice, please contact the office
manager. All complaints must be
submitted in writing. You will not be
penalized for filing a complaint.
This notice is effective April 2003 until further notice