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.
This Notice explains the ways in which
we may use and disclose medical information about you.
It describes your rights and certain obligations we
have regarding the use and disclosure of your medical
information. The law requires us to (1) Ensure your
medical information is protected; (2) Provide you with
this Notice describing our legal duties and privacy
practices with respect to medical information about
you; (3) Follow the current terms of the Notice in effect.
WAYS WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following sections describe different ways that
we may use and disclose your medical information. For
each category of uses or disclosures, we will explain
what we mean and try to give some examples. Not every
use or disclosure will be listed. All of the ways we
are permitted to use and disclose information, however,
will fall within one of the following categories.
Some information such as certain drug and alcohol
information, HIV information and mental health information
is entitled to special restrictions related to its use
and disclosure. Our office shall abide by all applicable
state and federal laws related to the protection of
this information.
1. Supplies. We may
use medical information about you to provide you with
medical supplies and services. We may disclose medical
information about you to doctors, nurses, technicians,
or other personnel who are involved in your care. For
example, a doctor treating you may need to know if you
have diabetes because diabetes may slow the healing
process. We may also share medical information about
you with our office personnel or other providers, agencies
or facilities in order to provide or coordinate such
things as prescriptions, CMN’s, lab cultures and
other medical documentation. We also may disclose medical
information about you to people outside our office who
may be involved in your continuing medical care after
you leave our office such as other home health care
providers, transport companies, community agencies and
family members.
2. Payment. We may
use and disclose medical information about the supplies
and services you receive from our office so that payment
may be collected from you, an insurance company or a
third party. For example, we may need to give information
to your health plan about supplies you received from
our office so your health plan will pay us or reimburse
you. We may also tell your health plan about a proposed
service in order to obtain prior approval or to determine
whether your plan will cover the treatment.
3. Internal Operations. We may use and disclose medical information about you
to support our office operations. These uses and disclosures
are made to improve our quality of service. Your medical
information may also be used or disclosed to comply
with laws and regulations, for contractual obligations,
patients. claims, grievances or lawsuits, health care
contracting, legal services, business planning and development,
business management and administration, the sale of
all or part of our office to another entity, underwriting
and other insurance activities. For example, we may
review medical information to find ways to improve services
to our patients. We may also disclose information to
doctors, nurses, technicians, and other personnel for
performance improvement and educational purposes.
4. Alternative Supplies. We may tell you about or recommend possible supply alternatives
that may be of interest to you.
5. Benefits and Services. We may contact you to tell you about benefits or services
that we provide.
6. Others Involved in Your
Care. We may release medical information to anyone
involved in your medical care, For example, a friend,
family member, personal representative, or an individual
you identify. We may give information to someone who
helps pay for your care or we may tell your family or
friends about your general condition.
7. Research. Your
medical information may be important to further research
efforts. We may use and disclose your medical information
for research purposes, subject to the confidentiality
provisions of state and federal law.
8. As Required By Law. We
will disclose medical information about you when required
to do so by federal or state law; If asked to do so
by law enforcement in response to a court or administrative
order, subpoena, discovery request, warrant, summons
or other lawful process; or for intelligence, counterintelligence,
and other national security activities authorized or
required by law.
9. To Avert a Serious Threat
to Health or Safety. We may use and disclose
medical information about you for public health purposes
or when necessary to prevent or lessen a serious and
imminent threat to your health and safety or the health
and safety of the public or another person. Any disclosure
would be to someone able to help stop or reduce the
threat.
10. Workers' Compensation. We may use or disclose medical information about you
for Workers' Compensation or similar programs as authorized
or required by law. These programs provide benefits
for work-related injuries or illness.
11. Inmates. If you
are an inmate of a correctional institution or under
the custody of law enforcement officials, we may release
medical information about you to the correctional institution
as authorized or required by law.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Although the medical information we obtain about you
is the property of our office, you do have the following
rights:
1. Inspect and Copy. With certain exceptions, you have the right to inspect
and/or receive a copy of your medical and billing information.
To inspect and/or to receive a copy of your information,
you must submit your request in writing to our Office
Manager at the 180 Medical address. If you request a
copy of the information, we may charge a fee for these
services. We may deny your request to inspect and/or
to receive a copy in certain limited circumstances.
If you are denied access to medical information, in
most cases, you may have the denial reviewed. Another
professional chosen by the our office will review your
request and the denial. The person conducting the review
will not be the person who denied your request. We will
comply with the outcome of the review.
2. Request an Amendment
or Addendum. If you feel that medical information
we have about you is incorrect or incomplete, you may
ask us to amend the information or add an addendum (addition
to the record). You have the right to request an amendment
or addendum for as long as the information is kept by
or our office. To request an amendment, your request
must be made in writing and submitted to our Office
Manager. In addition, you must provide a reason that
supports your request. We may deny your request for
an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may
deny your request if you ask us to amend information
that: Was not created by our office; Is not part of
the medical information kept by or for Our office; Is
not part of the information which you would be permitted
to inspect and copy; or Is accurate and complete in
the record. An addendum must not be longer than 250
words per alleged incomplete or incorrect item in your
record.
3. Accounting of Disclosures. You have the right to receive a list of the disclosures
we have made of medical information about you that were
for purposes other than treatment, payment, health care
operations and certain other purposes. To request this
accounting of disclosures, you must submit your request
in writing to our Office Manager. Your request must
state a time period that may not be longer than the
six previous years and may not include dates before
April 14, 2003. You are entitled to one accounting within
any 12-month period at no cost. If you request a second
accounting within that 12-month period, we may charge
you for the cost of compiling the accounting. We will
notify you of the cost involved and you may choose to
withdraw or modify your request at that time before
any costs are incurred.
4. Right to Request Restrictions. You have the right to request a restriction or
limitation on the medical information we use or disclose
about you for services, payment or health care operations.
You also have the right to request a limit on the medical
information we disclose about you to someone who is
involved in your care or the payment for your care,
such as a family member or friend. For example, you
could ask that we not use or disclose information to
a family member about a surgery you had. We are not
required to agree to your request. If we do agree, our
agreement must be in writing, and we will comply with
your request unless the information is needed to provide
emergency treatment. To request a restriction, you must
make your request in writing to our Office Manager.
In your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you want the
limits to apply, for example, disclosures to your spouse.
5. Right to Request Confidential
Communications. You have the right to request
that we communicate with you about medical matters in
a certain way or at a certain location. For example,
you can ask that we only contact you at work or by mail.
To request confidential communications, you must make
your request in writing to our Office Manager. We will
accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted.
6. Right to a Paper Copy
of This Notice. You have the right to a paper
copy of this Notice. You may ask us to give you a copy
of this Notice at any time. Even if you have agreed
to receive this Notice electronically, you are still
entitled to a paper copy of this Notice.
CHANGES TO OUR PRIVACY PRACTICES
AND THIS NOTICE
We reserve the right to change our office’s
privacy practices and this Notice. We reserve the right
to make the revised or changed Notice effective for
medical information we already have about you as well
as any information we receive in the future. We will
post a copy of the current Notice at our office. The
Notice will contain the effective date at the top of
the first page. In addition, at any time you may request
a copy of the current Notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated,
you may file a complaint with our Office Manager. All
complaints must be submitted in writing. You will not
be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information
not covered by this Notice or the laws that apply to
us will be made only with your written permission. If
you provide us permission to use or disclose medical
information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information
about you for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures
we have already made with your permission, and that
we will retain our records of the care provided to you
as required by law.
Effective Date: April 14,
2003 |
