Protected health information, about you, is maintained as a
record of your contacts or visits for healthcare services with our clinic. Specifically, Protected Heath 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 healthcare 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 healthcare 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
The 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 healthcare 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 ooperations. 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
The following are examples of uses and disclosures of your
protected healthcare information that we are permitted to make.
Treatment - We may use and disclose
your protected healthcare information to provide, coordinate, or manage your healthcare and any related services. This
includes the coordination or management of your healthcare with a third party that is involved in your care and treatment.
For example, we would disclose your protected healthcare information, as necessary, to a pharmacy that would fill your prescriptions.
We will also disclose your protected healthcare 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 healthcare information, as necessary, to contact you to remind you of your
appointment. We may contact you by phone or other means to provide results form 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 healthcare
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 of 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 healthcare 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 healthcare.
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 healthcare 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 you protected health information pulblic 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 you 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 Heath 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 personal 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 survellance, 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 of 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 Disclosure -
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.
