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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. Physicians have always protected the confidentiality of health information by sealing medical records away in file cabinets and refusing to reveal your information. Today, state and federal laws also attempt to ensure the confidentiality of this sensitive information. The federal government recently published regulations designed to protect the privacy of your health information. This "privacy rule" protects health information that is maintained by physicians, hospitals, other health care providers and health plans. The privacy rule also provides you certain rights, such as the right to have access to your medical records. However, there are exceptions; these rights are not absolute. We also take precautions in our office to safeguard your health information such as training our employees and employing computer security measures. Please feel free to ask your physician or our Privacy Officer about exercising your rights or how your health information is protected in our office. This Notice of Privacy Practices explains our privacy practices. It contains very important information about how your confidential health information is handled by our office. It also describes how you can exercise your rights with regard to your protected health information.
Understanding Your Health Record/Information: Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care of treatment. This information, often referred to as your health or medical record serves as a:
· basis for planning your care and treatment· means of communication among the many health professionals who contribute to your care· legal document describing the care you received· means by which you or a third-party payer can verify that services billed were actually provided· a tool in educating health professionals· a source of data for medical research· a source of information for public health officials charged with improving the health of the nation· a source of data for facility planning and marketing· a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information and make more informed decisions when authorizing disclosure to others.
Uses and Disclosures (1) Treatment - Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of diagnostic tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.(2) Payment - Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or workers’ compensation that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.(3) Health care operations - Your health information may be used as necessary to support the day-to-day activities and management of our medical practice. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.(4) Business Associates – There are some services provided in our organization through contracts with business associates. For example, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information. (5) Notification Purposes – We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location, and general condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you desire to restrict disclosure to family members or others, please notify your physician or our Privacy Officer. (6) Communication with Family – Health professionals, using their best judgement, 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. If you desire to restrict disclosure to family members or others, please notify your physician or our Privacy Officer. (7) Research – We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. (8) Food and Drug Administration (FDA) - We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement. (9) Funeral Directors and Coroners – We may disclose health information to a coroner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients of the medical practice to funeral directors as necessary to carry out their duties. (10) Workers’ Compensation – We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
(11) Public health reporting – As required by law, we may disclose your health information to public health agencies or legal authorities charged with preventing or controlling disease, injury, or disability. For example, we are required to report certain communicable diseases, elder abuse, etc. to the state’s public health department. (12) Correctional Institution – Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
(13) Law enforcement - Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.
(14) As Required by Law – We will disclose medical information about you when required to do so by federal, state or local law. For example, federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
(15) To Avert a Serious Threat to Health or Safety – We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. (16) 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.
(17) Legal Proceedings – We may disclose health information in response to a court order or valid subpoena.
(18) Other Uses and Disclosures Require your Authorization - Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
(19) Additional Uses and Disclosures: - Your health information will be used by our staff to send you appointment reminders. Information about Treatments - Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you.
Individual Rights You have certain rights under the federal privacy standards. These include: the right to request restrictions on the use and disclosure of your protected health information. In some cases it may not be feasible for us to agree to the requested restriction and by law we are not required to do so. the right to request communication of your health information by alternative means or at alternative locations the right to inspect and copy your protected health information the right to amend or submit corrections to your protected health information the right to receive an accounting of how and to whom your protected health information has been disclosed the right to receive a printed copy of this notice the right to revoke your authoriztion to use or disclose health information except to the extent that action has already been taken
Associates in Women’s Health Duties We are required by law to maintain the privacy of your protected health information, provide you with a notice as to our legal duties and privacy practices with respect to protected health information, abide by the terms of this notice, notify you if we are unable to agree to a requested restriction, and accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We will not use or disclose your health information without your authorization, except as described in this notice or provided by law.
Right to Revise Privacy Practices As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice. The revised policies and practices will be applied to all protected health information we maintain.
Requests to Inspect Protected Health Information You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Receptionist or Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
Complaints If you believe that your privacy rights have been violated, you can file a formal complaint with the medical practice’s Privacy Officer or the Office of Civil Rights, U.S. Department of Health and Human Services. You may obtain a Complaint Form by contacting the Receptionist or the Privacy Officer. You will not be penalized or otherwise retaliated against for filing a complaint.
Contact Person Requests to inspect, copy, or amend medical information must be made in writing and submitted to the Privacy Officer. Request for an accounting of disclosures must also be submitted to the Privacy Officer. If you have questions and would like additional information, you may contact the Privacy Officer at the following address/phone number:
Acknowledgment of Receipt of Notice of Privacy Practices Please sign the attached Acknowledgment indicating that you have received the medical practice’s Notice of Privacy Practices.
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